Long term benefit of one year infliximab administration for the treatment of chronic refractory pouchitis.

Abstract

BACKGROUND-AIM:

The aim of this study is to identify the long term benefit of one year infliximab administration for the treatment of chronic refractory pouchitis following ileo-pouch anal anastomosis (IPAA) for ulcerative colitis (UC).

METHODS:

Seven patients with chronic refractory pouchitis diagnosed by clinical, endoscopic and histological criteria received infliximab 5 mg/kg at 0, 2, and 6 weeks and thereafter every 2 months for 1 year. Three patients had fistulae (1 pouch-bladder, 2 perianal) and 4 extraintestinal manifestations (2 erythema nodosum, 2 arthralgiae). All patients were refractory to antibiotics and 3 to azathioprine. Crohn's disease was excluded after re-evaluation of the history and small bowel examination with enteroclysis or capsule endoscopy. Clinical response was classified as complete, partial and no response. Fistulae closure was classified as complete, partial and no closure. The pouchitis disease activity index (PDAI) was used as an outcome measure. All patients were followed up for 3 years after discontinuation of infliximab therapy.

RESULTS:

After 1 year of infliximab administration 5 patients had complete clinical response, 1 partial clinical response and 1 no response, while 2 out of the 3 patients with fistulae had a complete closure. The median PDAI dropped from 11 (baseline) (range, 10-14) to 5 (range, 3-8). Extraintestinal manifestations were in complete remission too. Three years after completion of therapy, all patients with complete clinical response at one year remained in remission.

CONCLUSIONS:

One year infliximab administration is associated with a long term benefit in patients with chronic refractory pouchitis following IPAA for UC.

• Authors: Nikos Viazis, Marios Giakoumis, Theodoros Koukouratos, Jiannis Anastasiou, Konstantina Katopodi, Georgios Kechagias, Elias Anastasopoulos, Efstathios Saprikis, Michail Chanias, George Tribonias, Dimitrios G Karamanolis
• Journal: Journal of Crohn's & colitis (J Crohns Colitis) Vol. 7 Issue 10 Pg. e457-60 (Nov 2013) ISSN: 1876-4479 [Electronic] England
• PMID: 23523672 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Antibodies, Monoclonal
• Infliximab

Topics

• Adult
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Antibodies, Monoclonal (therapeutic use)
• Arthralgia (complications, drug therapy)
• Chronic Disease
• Colitis, Ulcerative (surgery)
• Colonic Pouches (adverse effects, pathology)
• Cutaneous Fistula (complications, drug therapy)
• Erythema Nodosum (complications, drug therapy)
• Female
• Humans
• Infliximab
• Intestinal Fistula (complications, drug therapy)
• Male
• Pouchitis (complications, drug therapy)
• Severity of Illness Index
• Time Factors
• Urinary Bladder Fistula (complications, drug therapy)