S1883 Comparative Effectiveness of Vedolizumab vs Infliximab in the Management of Pouchitis: A Propensity-Matched Analysis

Introduction: Pouchitis is the most common complication after ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). Infliximab and recently vedolizumab are increasingly being used for chronic pouchitis. We aimed to compare clinical outcomes among patients treated with infliximab vs vedolizumab using a large real-world federated EHR network. Methods: We utilized the TriNetX Global Collaborative Network to identify adults (≥18 years) diagnosed with pouchitis with prior UC, who received either infliximab or vedolizumab after IPAA. Cohorts were mutually exclusive and excluded patients with concurrent C. difficile infection. Propensity score matching (1:1) was performed to balance demographics and comorbidities. Outcomes assessed included all-cause hospitalization, pouch excision/ileostomy, pouchoscopy, and recurrent pouchitis over a 10-year follow-up. Measures of association, including risk difference, risk ratio, and odds ratio (OR), confidence intervals (CI), and p values were calculated. Results: In the vedolizumab vs infliximab group (n = 353 each), the risk of hospitalization was similar between groups (40.2% vs 44.5%; OR 0.84, 95% CI 0.62–1.13; P = 0.253). Vedolizumab was associated with a significantly lower risk of pouch excision or ileostomy (20.7% vs 27.8%; OR 0.68, 95% CI 0.48–0.96; P = 0.028). In contrast, pouchitis recurrence was significantly more common in the vedolizumab group (75.1% vs 64.6%; OR 1.65, 95% CI 1.19–2.29; P = 0.002). Pouchoscopy rates were numerically higher with vedolizumab but did not reach statistical significance (53.8% vs 47.3%; OR 1.30, 95% CI 0.97–1.75; P = 0.083). Conclusion: Vedolizumab use in patients with pouchitis was associated with lower rates of pouch excision but higher rates of pouchitis recurrence compared to infliximab. Further prospective studies are warranted to confirm this association.