Long term outcomes of initial Infliximab therapy for inflammatory pouch pathology: a multi-centre retrospective study
File(s)
Accepted version
Author(s)
Type
Journal Article
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 are 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 for inflammatory disorders related to the ileoanal pouch. The primary outcome was the development of infliximab failure defined by early failure to infliximab or secondary loss of response to infliximab.
Results:
Thirty-four patients met the inclusion criteria; 18/34 (53%) who were initiated on infliximab for inflammatory disorders of the pouch had infliximab 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 follow-up
of 366 days (1-130 months).
Conclusions:
Initial infliximab therapy for pouch inflammatory conditions is associated with Infliximab 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.
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 are 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 for inflammatory disorders related to the ileoanal pouch. The primary outcome was the development of infliximab failure defined by early failure to infliximab or secondary loss of response to infliximab.
Results:
Thirty-four patients met the inclusion criteria; 18/34 (53%) who were initiated on infliximab for inflammatory disorders of the pouch had infliximab 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 follow-up
of 366 days (1-130 months).
Conclusions:
Initial infliximab therapy for pouch inflammatory conditions is associated with Infliximab 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.
Date Issued
2018-09-29
Date Acceptance
2018-06-27
Citation
Scandinavian Journal of Gastroenterology, 2018, 53 (9), pp.1051--1058
ISSN
0036-5521
Publisher
Taylor & Francis
Start Page
1051-
End Page
1058
Journal / Book Title
Scandinavian Journal of Gastroenterology
Volume
53
Issue
9
Copyright Statement
© 2018 Informa UK Limited, trading as Taylor & Francis Group. This is an Accepted Manuscript of an article published by Taylor & Francis in Scandinavian Journal of Gastroenterology on 29 September 2018, available online: https://doi.org/10.1080/00365521.2018.1496271
Identifier
https://www.tandfonline.com/doi/full/10.1080/00365521.2018.1496271
Subjects
Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Ileoanal pouch
biologics
infliximab
pouchitis
QUALITY-OF-LIFE
ANAL ANASTOMOSIS
CROHNS-DISEASE
REFRACTORY POUCHITIS
ULCERATIVE-COLITIS
PROCTOCOLECTOMY
METRONIDAZOLE
COMPLICATIONS
MANAGEMENT
TRIAL
Ileoanal pouch
biologics
infliximab
pouchitis
Adult
Colitis, Ulcerative
Colonic Pouches
Female
Humans
Ileostomy
Infliximab
Kaplan-Meier Estimate
Male
Middle Aged
Postoperative Complications
Pouchitis
Proctocolectomy, Restorative
Retrospective Studies
Treatment Failure
Colonic Pouches
Humans
Colitis, Ulcerative
Pouchitis
Postoperative Complications
Treatment Failure
Proctocolectomy, Restorative
Ileostomy
Retrospective Studies
Adult
Middle Aged
Female
Male
Kaplan-Meier Estimate
Infliximab
Gastroenterology & Hepatology
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2018-09-29