Jonathan P Segal1,2, Lawrence Penez1, Soad Mohsen Elkady1,3, Guy H T Worley1,2, Simon D McLaughlin4, Benjamin H Mullish5, Mohammed N Quraishi6,7, Nik S Ding8, Tamara Glyn8, Kesavan Kandiah9, Mark A Samaan10, Peter M Irving10, Omar D Faiz1,2, Susan K Clark1,2, Ailsa L Hart1,2. 1. a St Mark's Hospital , Harrow , UK. 2. b Department of Surgery and Cancer , Imperial College , London , UK. 3. c Department of Gastroenterology, Faculty of Medicine , University of Alexandria , Egypt. 4. d Department of Gastroenterology, The Royal Bournemouth and Christchurch Hospitals , Bournemouth , UK. 5. e Division of Digestive Diseases , St Mary's Hospital Campus, Imperial College , London , UK. 6. f Institute of Translational Medicine, University of Birmingham , Birmingham , UK. 7. g Department of Gastroenterology , University Hospital , Birmingham , UK. 8. h Department of Gastroenterology , St Vincent's Hospital , Melbourne , Australia. 9. i Department of Gastroenterology , Queen Alexandra Hospital , Portsmouth , UK. 10. j Department of Gastroenterology, Guy's & St Thomas' NHS Foundation Trust , London , UK.
Abstract
BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis is considered the procedure of choice in patients with ulcerative colitis refractory to medical therapy. Subsequent inflammation of the pouch is a common complication and in some cases, pouchitis fails to respond to antibiotics, the mainstay of treatment. In such cases, corticosteroids, immunomodulatory or biologic treatments are options. However, our understanding of the efficacy of anti-tumour necrosis factor medications in both chronic pouchitis and Crohn's-like inflammation is based on studies that include relatively small numbers of patients. METHODS: This was an observational, retrospective, multi-centre study to assess the long-term effectiveness and safety of infliximab (IFX) for inflammatory disorders related to the ileoanal pouch. The primary outcome was the development of IFX failure defined by early failure to IFX or secondary loss of response to IFX. RESULTS: Thirty-four patients met the inclusion criteria; 18/34 (53%) who were initiated on IFX for inflammatory disorders of the pouch had IFX failure, 3/34 (8%) had early failure and 15/34 (44%) had secondary loss of response with a median follow-up of 280 days (range 3-47 months). In total, 24/34 (71%) avoided an ileostomy by switching to other medical therapies at a median follow-up of 366 days (1-130 months). CONCLUSIONS: Initial IFX therapy for pouch inflammatory conditions is associated with IFX failure in just over half of all patients. Despite a high failure rate, an ileostomy can be avoided in almost three-quarters of patients at four years by using other medical therapies.
BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis is considered the procedure of choice in patients with ulcerative colitis refractory to medical therapy. Subsequent inflammation of the pouch is a common complication and in some cases, pouchitis fails to respond to antibiotics, the mainstay of treatment. In such cases, corticosteroids, immunomodulatory or biologic treatments are options. However, our understanding of the efficacy of anti-tumour necrosis factor medications in both chronic pouchitis and Crohn's-like inflammation is based on studies that include relatively small numbers of patients. METHODS: This was an observational, retrospective, multi-centre study to assess the long-term effectiveness and safety of infliximab (IFX) for inflammatory disorders related to the ileoanal pouch. The primary outcome was the development of IFX failure defined by early failure to IFX or secondary loss of response to IFX. RESULTS: Thirty-four patients met the inclusion criteria; 18/34 (53%) who were initiated on IFX for inflammatory disorders of the pouch had IFX failure, 3/34 (8%) had early failure and 15/34 (44%) had secondary loss of response with a median follow-up of 280 days (range 3-47 months). In total, 24/34 (71%) avoided an ileostomy by switching to other medical therapies at a median follow-up of 366 days (1-130 months). CONCLUSIONS: Initial IFX therapy for pouch inflammatory conditions is associated with IFX failure in just over half of all patients. Despite a high failure rate, an ileostomy can be avoided in almost three-quarters of patients at four years by using other medical therapies.
Authors: Bram Verstockt; Charlotte Claeys; Gert De Hertogh; Gert Van Assche; Albert Wolthuis; André D'Hoore; Séverine Vermeire; Marc Ferrante Journal: United European Gastroenterol J Date: 2019-08-20 Impact factor: 4.623