Published On: January 2018
Pouchitis Treatment Overview
Pouchitis is one of the most common complications of ileal pouch-anal anastomosis (IPAA) surgery and has a significant adverse impact on the quality of life. Pouchitis is an inflammation of the surgically constructed pouch. Various therapies are recommended for the treatment of pouchitis such as antibiotics, budesonide enemas, probiotics, butyrate suppositories, bismuth enemas, and others. For patients with acute pouchitis, antibiotics are the mainstay of therapy. Ciprofloxacin and metronidazole are the most commonly recommended antibiotics for the management of pouchitis. Metronidazole is associated with few short-term and long-term side effects which are limiting its use in comparison to ciprofloxacin.
Chronic antibiotic-refractory pouchitis (CARP) is found in a subset of patients, who do not respond to conventional antibiotic therapy. Treatment of CARP has been challenging, but a prolonged course of combined antibiotic therapy can be effective. Autoimmune pouchitis and IgG4-associated pouchitis are very rare and their treatment options include corticosteroids, immunomodulators, or anti-TNF biologics.
There are some pipeline drugs available for the management of pouchitis such as Alicaforsen by Atlantic Healthcare plc, and Vedolizumab by Takeda Pharmaceutical Company Limited.
The market for pouchitis treatment has been on the rise and has picked up the pace in the past few years. Based on MRFR analysis, the America pouchitis treatment market is growing at a healthy CAGR of around 8.34% and is expected to reach approximately USD 18.84 million by 2023 from USD 9.79 million in 2016. The innovation and developments in the pouchitis treatment market will continue to evolve the growth of the market in future.
How the current market scenario and what is propelling the market?
Currently, the America pouchitis treatment market is growing at a decent rate. The market is very niche as there is no specific targeted treatment available for the treatment of the pouchitis condition. As the first line of treatment is the use of antibiotics, the antibiotic companies are capitalizing on the current scenario and making the most of whatever they can get.
The major factors that are contributing to the growth of this market are rising prevalence of ulcerative colitis. According to a study published in the world journal of gastroenterology in 2015, the pathogenetic background of ulcerative collitis may contribute significantly to the development of pouchitis. As the Ileal pouch-anal anastomosis (IPAA) surgery is most commonly used for the treatment of ulcerative colitis, sometimes an outcome of this surgery appears to be pouchitis. It is observed that pouchitis complicates the outcome in around 8%-46% of patients with IPAA performed for ulcerative colitis. Apart from pouchitis, the IPAA surgery also causes some other complications such as pelvic sepsis, pelvic nerve damage among others. Despite these risks and complications, IPAA is still the most preferred procedure for ulcerative colitis. The increasing need and demand of ileal pouch-anal anastomosis procedure are also contributing to the growth of the pouchitis treatment market.
Another factor that propels the market growth is long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). According to a recent study, more than 70 million prescriptions for NSAIDs are written each year in the United States. With over-the-counter use included, currently, more than 30 billion doses of NSAIDs are consumed annually in the United States alone. Even though most of the NSAIDs are used in case of the inflammation and gastrointestinal diseases, the use of such drugs for a longer period of time affects the livers and intestines causing ulcers, colitis, and also pouchitis.
Besides that presence of certain antibodies such as perinuclear antineutrophil cytoplasmic antibody (pANCA) in the body also triggers the inflammation leading to chronic pouchitis.
Factors limiting market growth
Pouchitis is a very niche market with currently very little growth in terms of revenue. There is no specific treatment available for the treatment of the pouchitis. However, the majority of the cases of pouchitis are treated by using antibiotics. The extensive use of the antibiotics has shown many side effects to the patients. According to a study published in the Annals of Gastroenterology, around 33% of Metronidazole treated patients have reported adverse effects. There are certain side effects associated with the antibiotics such as nausea, vomiting, headache, skin rash, metallic taste, and abdominal discomfort. Although antibiotics have proved to be an effective treatment for acute pouchitis, patients can become dependent on antibiotics, and over the time can develop an antibiotic-resistant condition of the disease. All these factors are affecting the growth of the pouchitis treatment market.
Apart from that, stringent FDA regulations in the Americas are curbing the pouchitis treatment market. FDA approval of a drug is mandatory for marketing of the drug in the United States. Till now, not a single drug has been approved by the FDA which is targeted for the treatment of the pouchitis. Unavailability of the approved targeted drug therapy is also limiting the growth of the America Pouchitis Treatment Market.