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

Summary: 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. [ABSTRACT FROM AUTHOR]