Successful management of Crohn's disease of the ileoanal pouch with infliximab
Section snippets
Materials and methods
Medical records of all patients with CD and an IPAA treated with infliximab at the Mayo Clinic between October 1998 and March 1999 were reviewed. A centralized diagnostic index was used to identify all patients with diagnosis of UC, IPAA surgery, and reclassification of their diagnosis as CD; the resulting patient list was crossed with the pharmacy list of all patients treated with infliximab. The following data were obtained: demographic information, features of original diagnosis of UC, time
Patient characteristics
Seven patients with CD and an IPAA treated with infliximab were included in the study. Demographic data are shown in Table 1.Patient Age (yr) Sex Time from UC diagnosis to IPAA Time from IPAA to CD diagnosis Reasons for changing diagnosis 1 39 F 13 yr 7 yr Prepouch ileitis and perianal fistula 2 22 F 3 mo 3 yr Perianal and pouch-vaginal fistulas 3 30 F 5 yr 6 yr Prepouch ileitis and pouch-vaginal fistula 4 48 F 10 yr 4 yr Prepouch ileitis with granulomas on
Discussion
This is the first case series documenting the use of infliximab in the treatment of CD within ileal reservoirs. We observed clinical improvement in all patients with an IPAA and CD treated with infliximab, with complete clinical response in 6 of 7 patients (85.7%) and partial clinical response in 1 of 7 patients (14.3%). The administered dose of infliximab, 5 mg/kg, was previously determined to be the optimal dose in dose-response studies in patients with CD.10, [11] The median time interval
Acknowledgements
Dr. Sandborn has consulted for Centocor and participated in Centocor's Speaker Bureau Program. Dr. Panaccione has also participated in Centocor's Speaker Bureau Program. In addition, Drs. Sandborn and Ricart have received a grant from Centocor to fund this retrospective study.
References (13)
- et al.
Metronidazole therapy for perineal Crohn's disease: a follow-up study
Gastroenterology
(1982) - et al.
Clinical outcome following treatment of refractory inflammatory and fistulizing Crohn's disease with intravenous cyclosporine
Am J Gastroenterol
(1998) - et al.
Ileal pouch–anal anastomosis for chronic ulcerative colitis. Long-term results
Ann Surg
(1987) - et al.
Consequences of ileal–pouch anastomosis for Crohn's disease
Dis Colon Rectum
(1991) - et al.
Results of the pelvis-pouch procedure in patients with Crohn's disease
Dis Colon Rectum
(1991) - et al.
Ileal pouch anastomosis
Ann Surg
(1990)