Gastroenterology

Gastroenterology

Volume 117, Issue 2, August 1999, Pages 429-432
Gastroenterology

Successful management of Crohn's disease of the ileoanal pouch with infliximab

https://doi.org/10.1053/gast.1999.0029900429Get rights and content

Abstract

This study reports the clinical benefit and safety of the murine chimeric anti–tumor necrosis factor (TNF)-α monoclonal antibody, infliximab, in the treatment of patients who developed findings compatible with Crohn's disease after undergoing colectomy with ileal–pouch anal anastomosis (IPAA) for an original diagnosis of ulcerative colitis. Medical records of 7 patients with Crohn's disease and an IPAA treated with infliximab were reviewed. Clinical response was classified as complete response, partial response, and no response. Concurrent treatment with immune modifier agents and/or antibiotics was recorded. Seven patients with active inflammatory or fistulizing Crohn's disease and an IPAA performed for diagnosis of ulcerative colitis were treated with infliximab after they had no response to conventional therapies. Patients received 1-4 infliximab infusions at a dose of 5 mg/kg. All patients improved clinically. Six patients had a complete response, and 1 had a partial response. Four of the 5 patients with complex perianal and fistulizing disease had closure of all fistula tracts, and 1 patient improved temporarily. Six of the 7 patients underwent concurrent treatment with immune modifier drugs. One patient had myalgias and malaise after the first infliximab infusion and flu-like symptoms after the second one. No other adverse effects were observed. This case series demonstrates that the murine chimeric anti–TNF-α monoclonal antibody, infliximab, can be used successfully to treat patients with Crohn's disease involving an IPAA who are refractory to conventional therapies.

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.

. Table 1. Characteristics of 7 patients with CD involving the IPAA

PatientAge (yr)SexTime from UC diagnosis to IPAATime from IPAA to CD diagnosisReasons for changing diagnosis
139F13 yr7 yrPrepouch ileitis and perianal fistula
222F3 mo3 yrPerianal and pouch-vaginal fistulas
330F5 yr6 yrPrepouch ileitis and pouch-vaginal fistula
448F10 yr4 yrPrepouch 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.

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