INTRODUCTION: Ten to 15% of patients with pouchitis experience refractory or recurrent disease. Anti-TNF agents are effective in both refractory ulcerative colitis and Crohn's disease. AIMS & METHODS: This study aimed to evaluate the effectiveness of Infliximab (IFX) or Adalimumab (ADA) in inducing remission and improving quality-of-life (QOL) in such patients. From January 2007 to May 2009, 19 consecutive patients with refractory pouchitis were prospectively followed in a single tertiary center Patients with active pouchitis not responding after 1 month of antibiotic treatment (metronidazole 1g/day or ciprofloxacin 1g/ day) and 2 months of oral budesonide CIR at 9mg/day, were treated with IFX 5mg/kg at 0,2,6 weeks or ADA 160mg/80mg at weeks 0-2 and then 40 mg every-other-week. Shortterm efficacy was evaluated at week 10. Symptomatic, endoscopic and histological evaluations were done before and after treatment using the Pouchitis Disease Activity Index (PDAI) score. Remission was defined as a combination of a clinical PDAI score of 1. QOL was assessed using Inflammatory Bowel less or equal 2 and endoscopic PDAI score less or equal than Disease Questionnaire (IBDQ). RESULTS: Twelve patients (7 males, 5 females, median age 32,6 years) received IFX, 7 (5 males, 2 females, median age 36,4 years) were treated with ADA; 2 of the patients treated with ADA were secondary failure to IFX. Nine of 12 (75 %) and 5 of 7 (71,4%) showed remission respectively in the IFX and ADA group. The median PDAI scores before and after therapy were 13 (range 8-18) and 2 (range 0-9) in IFX group(p<0.001), and 14 (range 9-18) and 2 (range 0-10) in the ADA group (p<0.001). The median IBDQ score also significantly improved from 96 (range 74- 184) to 196 (range 92-230) in the IFX group (p<0.001), and from 105 (range 78-176) to 206 (range 94-226) in the ADA group (p<0.001).No serious side-effects were registered. CONCLUSION: IFX and ADA were both effective in inducing remission and improving QOL in patients with refractory pouchitis, and were well tolerated.
M1085 Use of Infliximab and Adalimumab in Refractory Pouchitis / Paolo Gionchetti; Giulia Straforini; Rosy Tambasco; Ramona Brugnera; Giulia Spuri Fornarini; Gilberto Poggioli; Silvio Laureti; Massimo Campieri; Fernando Rizzello. - In: GASTROENTEROLOGY. - ISSN 0016-5085. - STAMPA. - 138, Issue 5, Supp. 1:(2010), pp. 238-238. (Intervento presentato al convegno digestive disease week tenutosi a new orleans (USA) nel 1-5 maggio 2010).
M1085 Use of Infliximab and Adalimumab in Refractory Pouchitis
GIONCHETTI, PAOLO;POGGIOLI, GILBERTO;LAURETI, SILVIO;CAMPIERI, MASSIMO;RIZZELLO, FERNANDO
2010
Abstract
INTRODUCTION: Ten to 15% of patients with pouchitis experience refractory or recurrent disease. Anti-TNF agents are effective in both refractory ulcerative colitis and Crohn's disease. AIMS & METHODS: This study aimed to evaluate the effectiveness of Infliximab (IFX) or Adalimumab (ADA) in inducing remission and improving quality-of-life (QOL) in such patients. From January 2007 to May 2009, 19 consecutive patients with refractory pouchitis were prospectively followed in a single tertiary center Patients with active pouchitis not responding after 1 month of antibiotic treatment (metronidazole 1g/day or ciprofloxacin 1g/ day) and 2 months of oral budesonide CIR at 9mg/day, were treated with IFX 5mg/kg at 0,2,6 weeks or ADA 160mg/80mg at weeks 0-2 and then 40 mg every-other-week. Shortterm efficacy was evaluated at week 10. Symptomatic, endoscopic and histological evaluations were done before and after treatment using the Pouchitis Disease Activity Index (PDAI) score. Remission was defined as a combination of a clinical PDAI score of 1. QOL was assessed using Inflammatory Bowel less or equal 2 and endoscopic PDAI score less or equal than Disease Questionnaire (IBDQ). RESULTS: Twelve patients (7 males, 5 females, median age 32,6 years) received IFX, 7 (5 males, 2 females, median age 36,4 years) were treated with ADA; 2 of the patients treated with ADA were secondary failure to IFX. Nine of 12 (75 %) and 5 of 7 (71,4%) showed remission respectively in the IFX and ADA group. The median PDAI scores before and after therapy were 13 (range 8-18) and 2 (range 0-9) in IFX group(p<0.001), and 14 (range 9-18) and 2 (range 0-10) in the ADA group (p<0.001). The median IBDQ score also significantly improved from 96 (range 74- 184) to 196 (range 92-230) in the IFX group (p<0.001), and from 105 (range 78-176) to 206 (range 94-226) in the ADA group (p<0.001).No serious side-effects were registered. CONCLUSION: IFX and ADA were both effective in inducing remission and improving QOL in patients with refractory pouchitis, and were well tolerated.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
