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P149. Efficacy of infliximab rescue therapy in patients with chronic refractory pouchitis: A multicenter study [Grupo Joven GETECCU]

M. Barreiro-de Acosta1, R. Souto1, O. García-Bosch2, M. Mañosa3, J. Miranda4, V. García-Sánchez5, J. Gordillo6, S. Chacón7, D. Carpio8, N. Maroto9, L.A. Menchen4, M. Rojas-Fería10, M. Sierra11, A. Villoria12, I. Marín-Jimenez4

1University Hospital, Santiago de Compostela, Spain; 2Clinic, Barcelona, Spain; 3Germans Trias i Pujol, Badalona, Spain; 4Gregorio Marañón, Madrid, Spain; 5Reina Sofía, Córdoba, Spain; 6Santa Creu i Sant Pau, Barcelona, Spain; 7Morales Meseguer, Murcia, Spain; 8CHOP, Pontevedra, Spain; 9Manises, Valencia, Spain; 10Valme, Sevilla, Spain; 11Virgen Blanca, Leon, Spain; 12Parc Taulí, Sabadell, Spain

Aim: Despite medical therapy, 30% of patients with ulcerative colitis (UC) need to undergo surgery during the course of their disease. More than 25% 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 the efficacy of IFX in these patients and evaluate potential predictors of response.

Methods: A retrospective, open-label, multicenter study was designed. Patients older than 18 years with chronic refractory pouchitis treated with IFX (5 mg/kg) were included. Patients with histology suggestive of Crohn's disease after review of the colectomy specimen were excluded. Short and long term efficacy of IFX was evaluated at weeks 8, 26 and 52, respectively. Remission was defined as cessation of diarrhoea, urgency and blood loss and response as a marked clinical improvement, but persisting symptoms. The pouchitis disease activity index (PDAI) was calculated when available. The influence of gender, tobacco, extraintestinal manifestations, type of surgery and concomitant immunosuppressives on the efficacy of IFX therapy was analyzed. Results are shown as percentages, and were analyzed by the chi-square test and the Fisher exact test, as appropriate.

Results: Thirty-one consecutive UC patients with chronic refractory pouchitis were included (16 male, mean age 46, range 21–67), 13% percent were active smokers, 38% had extraintestinal manifestations and 52% received concomitant immunosuppressives. Refractory pouchitis developed after a mean of 49 months. Prior to IFX, 87% of patients had been treated with antibiotics, 28% with probiotics and 61% with immunosuppressive agents. After 8 weeks, 16% of patients with refractory pouchitis achieved remission and 64% showed clinical response. At week 8, 70% of patients had a significant decrease in PDAI score. At week 26, 26% achieved remission and 32% showed clinical response and at week 52, 26% achieved remission and 29% clinical response. Twelve patients (39%) withdrew treatment (4 because of lack of efficacy, 3 because loss of response and 5 for adverse events). Only male gender was associated with a better short-term response (p < 0.05), none of the other factors analyzed had influence in response to IFX.

Conclusions: IFX was effective in short and long-term in patients with chronic refractory pouchitis. However a high number of patients had to discontinue IFX. More studies are needed in order to evaluate the efficacy of IFX in the treatment of refractory pouchitis.