Inflamm Bowel Dis - Volume 16, Number 2, February 2010

Efficacy of Infliximab in Refractory Pouchitis and Crohn's Disease-Related Complications of the Pouch: A Belgian Case Series

Marc Ferrante, Geert D'Haens, Olivier Dewit, Filip Baert, Jan Holvoet, Karel Geboes, Gert De Hertogh, Gert Van Assche, Séverine Vermeire, and Paul Rutgeerts, on behalf of the Belgian IBD Research Group.

Abstract
BACKGROUND: Up to 25% of inflammatory bowel disease (IBD) patients undergoing surgery with an ileal pouch–anal anastomosis (IPAA) will develop chronic pouchitis not responding to antibiotics. In case reports, thiopurine analogs and infliximab (IFX) have been proposed as effective therapy in this setting. We analyzed the long-term efficacy of IFX in Belgian patients with refractory pouch complications.
 
METHODS: We identified 28 IPAA patients who received IFX for refractory luminal inflammation (pouchitis and/or pre-pouch ileitis, n ¼ 25) and/or pouch fistula (n ¼ 7). Patients with elements of Crohn’s disease after review of the colectomy specimen were excluded. Clinical response was defined as complete in case of
cessation of diarrhea, blood loss, and abdominal pain, and as partial in case of marked clinical improvement. Fistula response was defined as complete in case of cessation and as partial in case of reduction of fistula drainage.
 
RESULTS: Eighty-two percent of patients were concomitantly treated with immunomodulatory agents. At week 10 following start of IFX, 88% of patients with refractory luminal inflammation showed clinical response (14 partial, 8 complete), while 6 patients (86%) showed fistula response (3 partial, 3 complete). The mPDAI dropped significantly from 9.0 (interquartile range [IQR] 8.0–10.0) to 4.5 (3.0–7.0) points (P < 0.001). After a median follow-up of 20 (7–36) months, 56% showed sustained clinical response while 3 out of 7 fistula patients showed sustained fistula response. Five patients needed permanent ileostomy.