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

This study reports the clinical benefit and safety of the murine chimeric a nti-tumor necrosis factor (TNF)-alpha monoclonal antibody, infliximab, in t he treatment of patients who developed findings compatible with Crohn's dis ease after undergoing colectomy with ileal-pouch anal anastomosis (IPAA) fo r an original diagnosis of ulcerative colitis. Medical records of 7 patient s with Crohn's disease and an IPAA treated with infliximab were reviewed, C linical response was classified as complete response, partial response, and no response. Concurrent treatment with immune modifier agents and/or antib iotics 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 the rapies. Patients received 1-4 infliximab infusions at a dose of 5 mg/kg, Al l patients improved clinically. Six patients had a complete response, and 1 had a partial response. Four of the 5 patients with complex perianal and f istulizing disease had closure of all fistula tracts, and 1 patient improve d temporarily. Six of the 7 patients underwent concurrent treatment with im mune modifier drugs. One patient had myalgias and malaise after the first i nfliximab infusion and flu-like symptoms after the second one. No other adv erse effects were observed. This case series demonstrates that the murine c himeric antiTNF-alpha monoclonal antibody, infliximab, can be used successf ully to treat patients with Crohn's disease involving an IPAA who are refra ctory to conventional therapies.