TREATMENT STRATEGIES FOR POUCHITIS: STEP-UP VERSUS EARLY BIOLOGIC THERAPY
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.6025Keywords:
Pouchitis, Chronic Antibiotic-Refractory Pouchitis, Chronic Antibiotic-Dependent Pouchitis, Antibiotics, Biologic AgentsAbstract
Research objectives: This systematic review aims to assess and summarize the available evidence comparing step-up strategies versus early biologic therapy for pouchitis. The goal is to clarify their relative effectiveness, safety profiles, and impact on clinical outcomes to inform evidence-based treatment algorithms and identify gaps for future research.
Methods: A systematic review was conducted using PubMed, Google Scholar, and ResearchGate. Eligible studies included clinical trials, observational studies, systematic reviews, meta-analyses, and international guidelines published after 1990. Search terms combined RPC-IPAA, acute pouchitis, chronic pouchitis, step-up therapy, biologic therapy, antibiotics, immunosuppressants, and advanced therapies.
Key findings: Most patients with acute pouchitis treated with antibiotics achieved a short-term clinical response, although relapses and progression to chronic disease were common. Chronic combination antibiotic therapy maintained remission in approximately three-quarters of patients but was associated with bacterial resistance and adverse events. Biologic agents achieved response rates of approximately 60%, while remission remained ≤50%. Vedolizumab and ustekinumab showed higher long-term tolerability and treatment persistence than TNF inhibitors. Evidence of early biologic therapy was limited, and no clear association between early initiation and clinical outcomes was identified.
Conclusions: Step-up antibiotic therapy remains justified as the first-line treatment for pouchitis due to its high short-term efficacy. Biologic agents represent a valuable option for chronic or refractory disease but do not appear to be superior to antibiotics as initial treatment. Current evidence does not support routine early biologic therapy for all patients, although selected high-risk groups may benefit. Future prospective studies are needed to define optimal timing of biologic therapy.
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Copyright (c) 2026 Małgorzata Lubowiecka, Anna Szeszko, Zuzanna Lecyk, Agata Leszek, Natalia Moskwa, Iga B. Borejszo, Joanna H. Marczak, Ksenia O. Kobelak, Katarzyna Marut, Bianka A. Błaszkiewicz
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