@article{97bb77bb499949219c50bc47e2981fe4,
title = "Appropriateness of Medical and Surgical Treatments for Chronic Pouchitis Using RAND/UCLA Appropriateness Methodology",
abstract = "Background and Aims: The treatment of chronic pouchitis remains a challenge due to the paucity of high-quality studies. We aimed to provide guidance for clinicians on the appropriateness of medical and surgical treatments in chronic pouchitis. Methods: Appropriateness of medical and surgical treatments in patients with chronic pouchitis was considered in 16 scenarios incorporating presence/absence of four variables: pouchitis symptoms, response to antibiotics, significant prepouch ileitis, and Crohn{\textquoteright}s disease (CD)-like complications (i.e., stricture or fistula). Appropriateness of permanent ileostomy in patients refractory to medical treatments was considered in eight additional scenarios. Using the RAND/UCLA appropriateness method, international IBD expert panelists rated appropriateness of treatments in each scenario on a 1–9 scale. Results: Chronic antibiotic therapy was rated appropriate only in asymptomatic antibiotic-dependent patients with no CD-like complications and inappropriate in all other scenarios. Ileal-release budesonide was rated appropriate in 6/16 scenarios including patients with significant prepouch ileitis but no CD-like complications. Probiotics were considered either inappropriate (14/16) or uncertain (2/16). Biologic therapy was considered appropriate in most scenarios (14/16) and uncertain in situations where significant prepouch ileitis or CD-like complications were absent (2/16). In patients who are refractory to all medications, permanent ileostomy was considered appropriate in all scenarios (7/8) except in asymptomatic patients with no CD-like complications. Conclusions: In the presence of significant prepouch ileitis or CD-like complications, chronic antibiotics and probiotics are inappropriate. Biologics are appropriate in all patients except in asymptomatic patients with no evidence of complications. Permanent ileostomy is appropriate in most medically refractory patients.",
keywords = "Biologics, Budesonide, Chronic antibiotics, Chronic pouchitis, Crohn{\textquoteright}s disease-like complications, Permanent ileostomy, Prepouch ileitis, Probiotics, RAND appropriateness methodology",
author = "Gaurav Syal and Sparrow, {Miles P.} and Fernando Velayos and Cheifetz, {Adam S.} and Shane Devlin and Irving, {Peter M.} and Kaplan, {Gilaad G.} and Raffals, {Laura E.} and Thomas Ullman and Gecse, {Krisztina B.} and Fleshner, {Phillip R.} and Lightner, {Amy L.} and Siegel, {Corey A.} and Melmed, {Gil Y.}",
note = "Funding Information: Gaurav Syal has served as a consultant for Gilead and Prometheus Laboratories; speaker for HCPLive; and received research support from Pfizer. Miles P Sparrow has received educational grants or research support from Ferring, Orphan, and Gilead; speaker{\textquoteright}s fees from Janssen, Abbvie, Ferring, Takeda, Pfizer and Shire; and has served on advisory boards for Janssen, Takeda, Pfizer, Celgene, Abbvie, MSD, Emerge Health, and Gilead. Fernando Velayos has no relevant disclosures. Adam S Cheifetz has served as a consultant for Janssen, Abbvie, Takeda, Pfizer, Samsung, Arena, Bristol Myers Squibb, Prometheus, Bacainn, and Grifols and received research support from Inform Diagnostics. Shane Devlin has served as a speaker or consultant for Abbvie, Janssen, Takeda, Fresenius-Kabi, and Pfizer. Peter M Irving has served as a speaker or a consultant for AbbVie, Arena, Celgene, Ferring, Prometheus, Shire, Warner Chilcott, Takeda, MSD, Vifor Pharma, Pharmacosmos, Topivert, Gilead, Galapagos, BMS, Genentech, Hospira, Samsung Bioepis, VH2, Janssen, Sandoz, and Lilly, Roche; and has received research support from MSD, Pfizer, and Takeda . Gilaad G Kaplan served as a speaker or a consultant for Abbvie, Janssen, Pfizer, Amgen, Gilead, and Takeda; received research support from Ferring, Janssen, Abbvie, Glaxo-Smith Kline, Merck, and Shire; and shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent WO2019046959A1. PCT/CA2018/051098. 7 Sept. 2018. Laura Raffals has no relevant disclosures. Thomas Ullman has no relevant disclosures. Krisztina B Gecse has received grants from Pfizer Inc. and Celltrion; consultancy fees from AbbVie, Arena Pharmaceuticals, Galapagos, Gilead, Immunic Therapeutics, Janssen Pharmaceuticals, Novartis, Pfizer Inc., Samsung Bioepis, and Takeda and speaker{\textquoteright}s honoraria from Celltrion, Ferring, Janssen Pharmaceuticals, Novartis, Pfizer Inc, Samsung Bioepis, Takeda and Tillotts. Phillip R Fleshner has served as a consultant to Takeda. Amy L Lightner has served as a consultant to Takeda. Corey A Siegel has served as a consultant to Abbvie, BMS, Lilly, Janssen, Pfizer, Prometheus, Takeda, and Trellus Health; speaker for CME activities for Abbvie, Janssen, Pfizer, and Takeda; and received grant support from Abbvie, Janssen, Pfizer, and Takeda. Gil Y Melmed has served as a consultant to Abbvie, Arena, Boehringer-Ingelheim, Bristol-Meyer Squibb/Celgene, Entasis, Janssen, Medtronic, Pfizer, Samsung Bioepis, Shionogi, Takeda, and TechLab and received research funding from Pfizer. Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",
year = "2022",
month = oct,
doi = "10.1007/s10620-021-07362-y",
language = "English",
volume = "67",
pages = "4687--4694",
journal = "Digestive Diseases and Sciences",
issn = "0163-2116",
publisher = "Springer",
number = "10",
}