Mirikizumab for the treatment of chronic antibiotic-refractory pouchitis

Abstract

The current standard of care for the definitive surgical treatment of complicative ulcerative colitis is a continence-preserving proctocolectomy with the creation of an ileal pouch anal anastomosis. In addition to structural and functional disorders, pouchitis of the J-pouch is a common phenomenon, typically well responsive to antimicrobial therapy. However, sometimes chronic antibiotic-refractory pouchitis occurs, most often due to not completely understood multifactorial pathomechanisms. While high-quality evidence is available only for anti-integrin therapy, the role of advanced therapy, i.e., cytokine-antibodies or small molecules in the treatment of chronic antibiotic-refractory pouchitis (CARP), is emerging.

This case demonstrates a successful induction treatment of CARP with the novel p19-selective IL-23-targeted antibody mirikizumab.

Zusammenfassung

Das Standardverfahren zur definitiven Therapie der komplizierten Colitis ulcerosa ist die kontinenzerhaltende Proktokolektomie mit Anlage eines ileoanalen Pouches. Zusätzlich zu strukturellen und funktionellen Problemen kann mitunter die Pouchitis des J-Pouches auftreten, welche in der Regel gut auf kalkuliert antimikrobielle Therapie anspricht. Wesentlich seltener kann es zur chronischen, Antibiotika-refraktären Pouchitis (CARP) kommen, deren Pathogenese meist multifaktoriell und bis heute nicht vollständig verstanden ist. Zur Therapie der CARP existiert in der Literatur ein hohes Evidenzniveau nur für die Anti-Integrin-Therapie, mit Vedolizumab als einzigem, spezifisch für die CARP zugelassenen Medikament. Die Rolle weiterer Wirkklassen aus dem Bereich der Biologika und „small molecules“ ist derzeit Gegenstand intensiver Untersuchungen.

Der hier dargestellte Fall zeigt erstmals die erfolgreiche Induktionstherapie von CARP mit dem neuen, p19-selektiven IL-23-gerichteten Antikörper Mirikizumab.

Keywords

IBD - pouchitis - endoscopy - biologicals

Schlüsselwörter

CED - Pouchitis - Endoskopie - Biologika

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