title: Infliximab to Treat Refractory Inflammation After Pelvic Pouch Surgery for Ulcerative Colitis.
abstract: BACKGROUND
  Inflammatory pouch complications refractory to first-line therapies remain problematic following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). We evaluated infliximab efficacy and associations with therapeutic response.
  
  
  METHODS
  Data from individuals who underwent colectomy and IPAA for UC (2000-2014) were reviewed. Patients with chronic refractory pouchitis (CP) and Crohn's disease (CD)-like outcomes treated with infliximab were included. Pre-treatment parameters and response at median 8 (initial) and 48 weeks (sustained) were measured. Complete response was defined as symptomatic and endoscopic resolution with modified Pouchitis Disease Activity Index (mPDAI) <5. Partial response included mPDAI improvement >2. Serum was analysed for Anti-Saccharomyces cerevisiae antibodies (ASCA), anti-OmpC, anti-CBir1 and perinuclear Anti-Neutrophil Cytoplasmic Antibodies (pANCA).
  
  
  RESULTS
  One hundred and fifty-two patients with CP or a CD-like phenotype were identified. Forty-two were treated with infliximab (33% male; age 32.6±2.6 years, 28.5% CD-like). Post-induction response was achieved in 74% (48% complete) and sustained response in 62.6% (29.6% complete). Mean mPDAI and C-reactive protein declined from 8.5±0.3 to 2±3.4 (p < 0.002) and from 29.48±6.2 to 5.76±1.6mg/L (p < 0.001), respectively. Female gender, smoking and presence of anti-CBir1 were associated with infliximab use (p < 0.01) but not response. Pre-treatment mPDAI <10 (p < 0.01), resolution of rectal bleeding (p < 0.001 ) and week 8 endoscopic activity were associated with sustained response (p = 0.04; odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1-16.5]). More than 2 positive antimicrobial antibody titres were associated with non-response (p < 0.05), but did not retain significance in multivariate analysis (p = 0.197; OR 0.632; 95% CI 0.31-1.2).
  
  
  CONCLUSIONS
  Infliximab can effectively treat inflammatory pouch complications. Pre-treatment mPDAI <10 and early endoscopy may identify responders.
authors.affiliation: Division of Gastroenterology, University of Toronto, Mount Sinai Hospital, Toronto, Canada OKelly@mtsinai.on.ca.
authors.forename: Orlaith B
authors.initials: OB
authors.lastname: Kelly
authors.affiliation: Division of Gastroenterology, University of Toronto, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rosenberg
authors.affiliation: Zane Cohen Center for Digestive Disease, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Tyler
authors.affiliation: Zane Cohen Center for Digestive Disease, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Stempak
authors.affiliation: Division of Gastroenterology, University of Toronto, Mount Sinai Hospital, Toronto, Canada.
authors.forename: A Hillary
authors.initials: AH
authors.lastname: Steinhart
authors.affiliation: Zane Cohen Center for Digestive Disease, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Zane
authors.initials: Z
authors.lastname: Cohen
authors.affiliation: Division of Gastroenterology, University of Toronto, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Greenberg
authors.affiliation: Division of Gastroenterology, University of Toronto, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Silverberg
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D019449:Pouchitis / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D000069285:Infliximab
keywords: Ileal pouch–anal anastomosis; inflammatory bowel disease; infliximab; pouchitis