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P447. Long term benefit of one year infliximab administration for the treatment of chronic refractory pouchitis

N. Viazis1, M. Giakoumis1, J. Anastasiou1, K. Katopodi1, G. Kechagias1, G. Tribonias1, D. Karamanolis1, 1Evangelismos Hospital, 2nd Department of Gastroenterology, Athens, Greece

Background

Infliximab administration is currently recommended for the management of chronic refractory pouchitis, following ileo-pouch anal anastomosis (IPAA) for ulcerative colitis (UC). However, the optimal time that it needs to be administered is not known. Our study aimed to identify the long term benefit of one year infliximab administration for the treatment of chronic refractory pouchitis.

Methods

Seven patients (4 females, 3 males) with chronic refractory pouchitis were included in an open study. Pouchitis was diagnosed by clinical plus endoscopic and histological criteria. Three patients had also fistulae (pouch-bladder in 1 and perianal in 2). Extraintestinal manifestations were also present in 4 patients (erythema nodosum in 2, arthralgiae in 2). All patients were refractory to antibiotics, while 3 patients were refractory to azathioprine as well. Crohn's disease was carefully excluded in all patients after re-evaluation of the history and examination of the small bowel with enteroclysis or small bowel capsule endoscopy. Patients received Infliximab 5 mg/kg at 0, 2 and 6 weeks and thereafter every 2 months for 1 year. Clinical response was classified as complete, partial, and no response. Fistulae closure was classified as complete, partial, and no closure. The pouchitis disease activity index (PDAI) was also used as an outcome measure. All patients were followed up for 3 years after discontinuation of infliximab administration for signs and symptoms of disease recurrence.

Results

After 1 year of infliximab administration all patients improved clinically. Six out of the 7 patients had a complete clinical response and 1 patient a partial clinical response, while 2 out of the 3 patients with a fistula had complete fistulae closure. The median PDAI dropped from 11 (baseline) (range, 10–14) to 5 (range, 3–8). Extraintestinal manifestations were in complete remission as well. Three years after completion of therapy, all patients remained in remission and no one needed any kind of additional treatment for pouchitis during this 3-year follow up period.

Conclusion

One year infliximab administration is associated with a long term benefit in patients with chronic refractory pouchitis, complicated or not by fistulae, following IPAA for UC.