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P267. Efficacy of adalimumab rescue therapy in patients with chronic refractory pouchitis previously treated with infliximab [Grupo Joven GETECCU]

M. Barreiro-de Acosta1, O. García-Bosch2, J. Gordillo3, M. Mañosa4, L.A. Menchen5, R. Souto1, I. Marín-Jimenez5

1University Hospital, Santiago de Compostela, Spain; 2Clinic, Barcelona, Spain; 3Santa Creu i Sant Pau, Barcelona, Spain; 4Germans Trias i Pujol, Badalona, Spain; 5Gregorio Marañón, Madrid, Spain

Aim: Pouchitis is not uncommon in patients with proctocolectomy with ileal pouch-anal anastomosis (IPAA). In refractory pouchitis infliximab (IFX) has been used as a rescue therapy. In case of fail of IFX, a second biologic could be use in order to avoid permanent ileostomy, but there is not clinical evidence for the use of adalimumab (ADA) in this patients. The aim of this study was to report the efficacy of ADA in patients with refractory pouchitis previously treated with IFX.

Methods: A retrospective, open-label, multicenter study was designed. Patients older than 18 years with chronic refractory pouchitis treated ADA (160/80 mg induction and 40 mg every other week as maintenance) were included. All patients were previously treated with IFX. Patients with histology suggestive of Crohn's disease after review of the colectomy specimen were excluded. Short and long term efficacy of ADA was evaluated at week 8 and weeks 26 y 52, respectively. Remission was defined as cessation of diarrhoea, urgency and blood loss and response when there was significant clinical improvement, but persisting symptoms. The influence of gender, cause of IFX discontinuation, extraintestinal manifestations and concomitant immunosuppressives on the efficacy of ADA therapy was analyzed. Results are shown as percentages, and were analyzed by the chi-square test and the Fisher exact test, as appropriate.

Results: Eight consecutive UC patients with chronic refractory pouchitis treated with ADA were included (62% male, mean age 43 years, range 21–61). Mean of years since UC was diagnosed was 13 (range 2–28). Refractory pouchitis developed after a mean of 34 months (range 5–144). Prior to ADA, all patients had been treated with IFX, 5 (62%) withdrew IFX for adverse events and 3 (38%) because loss of response. After 8 weeks, 13% of patients with refractory pouchitis achieved remission and 62% showed clinical response. At week 26, 13% achieved remission and 38% showed clinical response. At week 52, 50% of patients avoided permanent ileostomy, but only 25 achived remission. None of the predictive factors analyzed had influence in the response to ADA.

Conclusions: ADA treatment was an alternative treatment in patients with chronic refractory pouchitis who fail IFX. After one year 50% of patients avoided permanent ileostomy. More studies are needed in order to evaluate the efficacy of ADA in the treatment of refractory pouchitis.