S1548 Patients in the Current Era Are More Likely to Utilize Novel Mechanisms of Action for the Treatment of Chronic Inflammatory Conditions of the Pouch

Introduction: Despite traditionally being depicted as a curative surgery, approximately 25% of patients will develop a chronic inflammatory condition of the pouch after proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. In patients with chronic pouchitis or Crohn’s-like disease of the pouch (CLDP), advanced therapies represent a common method of treatment. The relative effectiveness of these therapies and treatment patterns in the current era are not well defined. Thus, the goal of this study was to examine trends in the first advanced therapy after IPAA for UC with a focus on shifts in therapy patterns with the emergence of new mechanisms of action and their relative effectiveness. Methods: We performed a retrospective cohort study to evaluate patterns in the first advanced therapy utilized after IPAA between 1/1/2012 and 10/1/2024. We separated treatment periods into early (2012-2016) and current treatment periods (2017-2024) to evaluate therapy use over time and the relative effectiveness of therapies, defined by clinical remission or response at 6 months after induction. We used Chi-square, Fisher-exact, and Wilcoxon-rank-sum testing as appropriate as well as multivariable analysis to control for potential confounders. Results: A total of 56 patients were treated with advanced therapies after IPAA, of whom 2 (treated in the early period) did not receive any advanced therapy prior to surgery. Patients in the later time period were numerically less likely to use the same class of therapy (33% vs 67%, P = 0.061), however this was not statistically significant. In a multivariable analysis adjusting for pouch-related diagnosis, patients in the later time period were less likely to use the same class of therapy (aOR 0.12, 95% CI 0.02-0.86). There was no significant difference when comparing clinical remission at 6 months among patients who used a new class of therapy to those who used the same therapy after IPAA (45% vs 35%, P = 0.472) or clinical response (77% vs 55%, P = 0.108). Conclusion: In this retrospective analysis, we demonstrated that patients in recent years are more likely to utilize a new mechanism of action for the treatment of inflammatory conditions of the pouch than those in earlier time periods. These findings indicate the need for prospective, rigorous study of new mechanisms of action in the treatment of inflammatory conditions of the pouch, including studies of comparative effectiveness.