Adalimumab Shows Efficacy for Ileal Pouch Crohn Disease

Complete response was 50% for induction therapy and 33% for maintenance therapy.

Some patients who undergo ileal pouch anal anastomosis develop Crohn disease in the ileal pouch. Several studies have demonstrated the efficacy of infliximab in the management of this disease (JW Gastroenterol Nov 25 2003). The current open-label trial tested the efficacy of adalimumab in 48 patients treated at a center with extensive experience in management of pouch diseases.

Patients received adalimumab using the standard regimen for ulcerative colitis or Crohn disease. Six patients had received prior treatment with infliximab and experienced either infusion reactions or no response. The majority of patients received other medical therapies concomitant with adalimumab, and about half of patients underwent endoscopic therapies, including endoscopic balloon dilation in 20 patients and needle knife therapy of strictures in 5 patients.

At a median follow-up of 8 weeks, 50% of patients had a complete response, defined as complete resolution of pouch symptoms, reduction in bowel movement frequency to baseline, and closure of fistulae if present, as well as reduction of the modified pouchitis disease activity index to <5. Another 21% of patients had a partial response. Response was similar in inflammatory or fibrostenotic Crohn disease and fistulizing Crohn disease, with a numerically higher complete response in the fistulizing group (56% vs. 44%). At a median follow-up of 25 months, 33% of patients maintained remission, and 21% maintained partial response.

Citation(s):

Li Y et al. Adalimumab therapy in Crohn's disease of the ileal pouch. Inflamm Bowel Dis 2012 Dec; 18:2232.