Año 2024 / Volumen 116 / Número 12
Carta
Broadening perspectives in the treatment of chronic pouchitis

724-725

DOI: 10.17235/reed.2024.10865/2024

Carolina Broco Fernández, Mónica Sierra Ausín, Irene Latras Cortés, Verónica Patiño Delgadillo, Patricia Suárez Álvarez, Francisco Jorquera Plaza,

Resumen
We present the case of a 64-year-old male diagnosed with corticosteroid-dependent ulcerative colitis in 1999, who underwent total proctocolectomy with a J-pouch in 2005. Three years later, he developed recurrent histologically confirmed pouchitis, with clinical worsening. Several therapies were tried, including Infliximab, which provided stability for six years, until the development of antibodies led to moderate pouchitis in the rectal stump. Attempts with Adalimumab, Vedolizumab, and Ustekinumab failed, leading to worsening cuffitis, pouchitis, and anastomotic stenosis. Tofacitinib was started at 10 mg/12h, leading to a >50% reduction in fecal calprotectin and a PDAI drop from 4 to 0 within four weeks. After reducing the dose to 5 mg/12h, disease control was maintained, and the patient remains asymptomatic after two years and seven months, with normal colonoscopy findings showing complete mucosal healing. Despite advances in treatment, around 15% of ulcerative colitis patients require surgery, and 30-50% of those develop acute or chronic cuffitis or pouchitis. Tofacitinib, a JAK inhibitor, is approved for ulcerative colitis but has shown inconsistent results in treating pouchitis and cuffitis. While some studies report a lack of efficacy, others show potential responses in refractory cases. More research with larger patient cohorts is needed to better understand the role of JAK inhibitors in this context.
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Bibliografía
Okano S, Yoshimura N, Sako M, Takazoe M. A case of refractory chronic pouchitis successfully treated with tofacitinib. Clin J Gastroenterol. 2020;13(4):560-563. doi:10.1007/s12328-020-01108-5
Sandborn WJ, Su C, Sands BE, et al. Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med. 2017;376(18):1723-1736. doi:10.1056/NEJMoa1606910
Akiyama S, Cohen NA, Kayal M, Dubinsky MC, Colombel JF, Rubin DT. Treatment of Chronic Inflammatory Pouch Conditions With Tofacitinib: A Case Series From 2 Tertiary IBD Centers in the United States. Inflamm Bowel Dis. 2023 Sep 1;29(9):1504-1507. doi: 10.1093/ibd/izad011. PMID: 36745039; PMCID: PMC10472733.
Dalal RS, Bains K, Marcus J, McClure EL, Allegretti JR. Tofacitinib for the Treatment of Pouch-Related Disorders: A Case Series. Inflamm Bowel Dis. 2022;28(11):1787-1789. doi:10.1093/ibd/izac147
Taxonera Carlos, Carpio López Daniel, Cabez Manas Ana, Hinojosa del Val Joaquin Ernesto. Clinical settings with tofacitinib in ulcerative colitis. Rev Esp Enferm Dig 2022. doi: 10.17235/reed.2022.8660/2022.
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Instrucciones para citar
Broco Fernández C, Sierra Ausín M, Latras Cortés I, Patiño Delgadillo V, Suárez Álvarez P, Jorquera Plaza F, et all. Broadening perspectives in the treatment of chronic pouchitis. 10865/2024


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Ficha Técnica

Recibido: 12/10/2024

Aceptado: 19/10/2024

Prepublicado: 12/11/2024

Publicado: 13/12/2024

Tiempo de prepublicación: 31 días

Tiempo de edición del artículo: 62 días


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