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

Abstract

Background—AIMThe 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). MethodsSeven patients with chronic refractory pouchitis diagnosed by clinical, endoscopic and histological criteria received infliximab 5mg/kg at 0, 2, and 6weeks and thereafter every 2months for 1year. 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 3years after discontinuation of infliximab therapy. ResultsAfter 1year 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. ConclusionsOne year infliximab administration is associated with a long term benefit in patients with chronic refractory pouchitis following IPAA for UC.