Systematic review and meta-analysis of randomised controlled trials: Medical therapies for the treatment and prevention of pouchitis

Lotus Alphonsus, Theshani A. De Silva, Christopher Ma, John K. MacDonald, Jurij Hanzel, Melanie Beaton, Talat Bessissow, Maia Kayal, Rocio Sedano, Siddharth Singh, Vipul Jairath

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1 Scopus citations


Background and Aims: We conducted a systematic review to assess medical therapy for the treatment and prevention of pouchitis. Methods: Randomised controlled trials (RCTs) of medical therapy in adults with or without pouchitis were searched to March 2022. Primary outcomes included clinical remission/response, maintenance of remission and prevention of pouchitis. Results: Twenty RCTs (N = 830) were included. Acute pouchitis: One study compared ciprofloxacin with metronidazole. At 2 weeks, 100% (7/7) of ciprofloxacin participants achieved remission, compared with 67% (6/9) of metronidazole participants (RR: 1.44, 95% CI: 0.88–2.35, very low certainty evidence). One study compared budesonide enemas with oral metronidazole. Fifty percent (6/12) of budesonide participants achieved remission compared with 43% (6/14) of metronidazole participants (RR: 1.17, 95% CI: 0.51–2.67, low certainty evidence). Chronic pouchitis: Two studies (n = 76) assessed De Simone Formulation. Eighty-five percent (34/40) of De Simone Formulation participants maintained remission at 9–12 months compared with 3% (1/36) placebo participants (RR: 18.50, 95% CI: 3.86–88.56, moderate certainty evidence). One study assessed vedolizumab. Thirty-one percent (16/51) of vedolizumab participants achieved clinical remission at 14 weeks compared with 10% (5/51) of placebo participants (RR: 3.20, 95% CI: 1.27–8.08, moderate certainty evidence). Prophylaxis: Two studies assessed De Simone Formulation. Ninety percent (18/20) of De Simone Formulation participants did not develop pouchitis compared with 60% (12/20) of placebo participants (RR: 1.50, 95% CI: 1.02–2.21, moderate certainty evidence). Conclusions: Apart from vedolizumab and the De Simone formulation, the effects of other medical interventions for pouchitis are uncertain.

Original languageEnglish
Pages (from-to)268-282
Number of pages15
JournalAlimentary Pharmacology and Therapeutics
Issue number3
StatePublished - Aug 2023


  • Pouchitis
  • randomised controlled trials
  • treatment


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