Pouchitis is a considerable complication of ileal pouch-anal anastomosis, such as ulcerative colitis (UC); however, according to researchers, there have been no direct head-to-head comparisons of pouchitis therapies. The researchers conducted a meta-analysis of various treatments for acute and chronic pouchitis and concluded that antimicrobial therapy should remain the recommended treatment, per current guidelines.
Based on their findings, published in the European Journal of Gastroenterology & Hepatology, the authors also proposed that rifaximin and probiotics may warrant a more distinguished role in the treatment of pouchitis in patients with UC.
The network meta-analysis included 18 studies, which were evaluated via the frequentist model with pooled relative risk and P score calculations to rank the different treatments. According to the authors, rifaximin was the best antibiotic for acute pouchitis when compared to placebo, whereas ciprofloxacin was ranked the highest when compared to metronidazole. In chronic pouchitis, “metronidazole followed by probiotics was a statistically significant and effective treatment in inducing remission,” authors stated, though they noted that metronidazole had the highest frequency of adverse events.
Additionally, adalimumab and bismuth were superior to placebo, though not to a statistically significant degree. Probiotics also proved superior to placebo in the prevention of pouchitis.
This analysis was, to the authors’ knowledge, the first to directly compare treatments for acute and chronic pouchitis. Ultimately, they supported the currently recommended use of antimicrobial therapy, and stated that, “while biologics are starting to show promise, large-scale head-to-head comparisons are warranted to validate the efficacy of these treatments.”