IL-23 Inhibitors Show Clinical, Endoscopic Efficacy in Chronic Pouch Disorders
Clinical Summary:
- IL-23 inhibitors: A multicenter retrospective cohort presented at ACG, October 2026, included 149 patients with ileal pouch-anal anastomosis treated during 2022–2026 with ≥3 months’ follow-up; 94% had Crohn’s-like pouch disease and 86.6% had prior biologic exposure.
- Clinical and endoscopic outcomes: Clinical remission occurred in 50.3% and endoscopic remission in 31.6%.
- Clinical relevance and next steps: Therapy changes occurred in 26.2%, IBD-related emergency visits/hospitalizations in 13.4%, and pouch excision/diversion in 10.7%. Findings support prospective controlled trials; no confidence intervals or P values were provided.
Interleukin-23 (IL-23) inhibitors demonstrated clinical and endoscopic efficacy in patients with chronic pouch disorders following ileal pouch-anal anastomosis (IPAA), according to findings from a multicenter retrospective cohort study.
Investigators evaluated 149 patients with IPAA who received IL-23 inhibitors between 2022 and 2026 and had at least 3 months of follow-up. The mean patient age was 50 years, 45.6% were women, and Crohn’s-like disease of the pouch (CLDP) accounted for 94% of pouch phenotypes. Mean pouch age was 18 years.
Risankizumab was used by 81.2% of patients and guselkumab by 18.8%. The cohort was heavily treatment-experienced, with 86.6% previously exposed to biologic therapy and 81.2% exposed to anti-TNF treatment.
Clinical remission was achieved by 50.3% of patients and clinical response by 47.8%, with 70.8% achieving either clinical remission or response. Endoscopic remission occurred in 31.6%, while 46.8% achieved an endoscopic response. Overall, 63% achieved endoscopic remission or response.
Additional outcomes included perianal fistula healing in 48.3% of patients and fecal calprotectin normalization to less than 200 µg/g in 56.8%. Therapy changes were required in 26.2% after at least 3 months of treatment. IBD-related emergency department visits or hospitalizations occurred in 13.4%, while 10.7% underwent IBD-related surgery involving pouch excision or diversion.
Among patients achieving endoscopic remission, 97% received risankizumab and 69% were women. Prior biologic or anti-TNF exposure, pouch phenotype, and perianal fistulas did not influence clinical or endoscopic remission rates.
“IL-23 inhibitors demonstrated meaningful clinical and endoscopic efficacy in a predominantly biologic-exposed cohort of patients with IPAA,” the investigators concluded.
The findings support further prospective controlled trials evaluating IL-23 inhibition for pouch disorders.
Reference
Laoveeravat P, Farooq A, Zayat MN, et al. The efficacy of anti-interleukin 23 use in patients with ileal pouch anal anastomosis: real-world data from multitertiary care centers. Presented at: American College of Gastroenterology; October 9-14, 2026; Nashville, TN.
