P058 Tofacitinib and Ileal Pouch Anal Anastomosis. A Single-Center Case Series.

Abstract

BACKGROUND: Tofacitinib is an emerging off label option for patients with moderate to severe ulcerative colitis (UC). However, data about the postoperative complications after ileal pouch anal anastomosis (IPAA), and the long-term pouch function after using tofacitinib are scarce. This study aims to describe postoperative complications and pouch function for patients with UC who had prior exposure to tofacitinib preoperatively. METHODS: After institutional review board approval, electronic medical records were reviewed for patients with UC treated with tofacitinib and subsequently underwent IPAA. Demographics, anthropometrics, previous treatments, smoking, preoperative risk factors and comorbidities, postoperative complications, and long-term pouch function were evaluated. RESULTS: A total of 13 patients were included. Of them, 10 (76.9%) were male, 1 (7.7%) current smoker, 1 (7.7%) had primary sclerosing cholangitis (PSC), 13 (100%) had ≥ previous 3 lines of treatment for UC. The median age at diagnosis was 23 years (IQR 21.5 – 34) and the median duration of UC was 10 years (IQR 4 – 17.5). All patients had previously failed tumor necrosis factor-alpha inhibitors and steroids while 11 (85%) patients failed aminosalicylate and 7 (54%) failed thiopurines. The most common dose used for tofacitinib prior to colectomy was 10 mg twice per day 8 (62%) and most patients had three-stage operation 11 (85%). No 90-day postoperative Clavien Dindo class III or IV complications were reported, no intra-abdominal sepsis, no other infectious complications, and no mortality. At a median follow up of 4 months (IQR 3.2 – 10.3), 3 (23.1%) patients had pouchitis, of whom 1 had a prior history of PSC and liver transplantation. Only 1 out of the 3 patients who had pouchitis needed a permanent stoma, the other 2 were managed medically. One of these patients also had had clostridium difficile infection. CONCLUSION: No major postoperative complications were reported after IPAA for patients who were treated with tofacitinib. From a surgical standpoint, tofacitinib was not associated with surgical complications in our small cohort of medically refractory UC patients. Pouch function was similar to expected in this patient population. Larger scale studies with longer follow up are needed to confirm these findings.