title: Efficacy of infliximab rescue therapy in patients with chronic refractory pouchitis: a multicenter study.
abstract: BACKGROUND
  Despite medical therapy, 30% of patients with ulcerative colitis (UC) need to undergo surgery. Around 50% of patients with proctocolectomy with ileal pouch-anal anastomosis (IPAA) develop complications of the pouch. Clinical evidence for the use of infliximab (IFX) in refractory pouchitis is limited. The aim of this study was to report efficacy of IFX in these patients.
  
  
  METHODS
  A retrospective, multicenter study was designed. Patients older than 18 years with chronic refractory pouchitis treated with IFX (5 mg/kg) were included. Short-term IFX efficacy was evaluated at week 8 and mid-term efficacy at weeks 26 and 52. Complete response was defined as cessation of diarrhea and urgency and partial response as marked clinical improvement but persisting symptoms. The modified Pouchitis Disease Activity Index (mPDAI) without endoscopy was calculated when available.
  
  
  RESULTS
  Thirty-three consecutive UC patients with chronic refractory pouchitis were included (18 male, mean age 45 years, range 21-67). At week 8, 21% patients achieved complete response and 63% showed partial clinical response. At weeks 26 and 52, 33% and 27% achieved complete response and 33% and 18% showed partial clinical response, respectively. Thirteen patients (39%) withdrew treatment (four for lack of efficacy, four for loss of response and five for adverse events). None of the potential factors analyzed had an influence on response to IFX.
  
  
  CONCLUSIONS
  IFX was effective in the short- and mid-term in patients with chronic refractory pouchitis. However, medication had to be discontinued in a high number of patients.
authors.affiliation: Gastroenterology Units of Hospitals, Clínico Universitario, Santiago de Compostela, Spain. manubarreiro@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Barreiro-de Acosta
authors.forename: O
authors.initials: O
authors.lastname: García-Bosch
authors.forename: R
authors.initials: R
authors.lastname: Souto
authors.forename: M
authors.initials: M
authors.lastname: Mañosa
authors.forename: J
authors.initials: J
authors.lastname: Miranda
authors.forename: V
authors.initials: V
authors.lastname: García-Sanchez
authors.forename: J
authors.initials: J
authors.lastname: Gordillo
authors.forename: S
authors.initials: S
authors.lastname: Chacon
authors.forename: C
authors.initials: C
authors.lastname: Loras
authors.forename: D
authors.initials: D
authors.lastname: Carpio
authors.forename: N
authors.initials: N
authors.lastname: Maroto
authors.forename: L
authors.initials: L
authors.lastname: Menchén
authors.forename: M
authors.initials: M
authors.lastname: Rojas-Feria
authors.forename: M
authors.initials: M
authors.lastname: Sierra
authors.forename: A
authors.initials: A
authors.lastname: Villoria
authors.forename: I
authors.initials: I
authors.lastname: Marin-Jimenez
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019449:Pouchitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016737:Proctocolectomy, Restorative; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab