Inflammatory complications including chronic refractory pouchitis and Crohn’s disease-like complications of the pouch are common complications after ileal pouch-anal anastomosis following colectomy for ulcerative colitis.
Dr Anthony Buisson and colleagues from France performed a systematic review and meta-analysis to evaluate the efficacy of anti-tumor necrosis factors therapy in distinguishing patients with chronic refractory pouchitis from those with Crohn’s disease-like complications of the pouch.
The researchers performed a systematic literature search to identify articles and abstracts reporting anti-tumor necrosis factors agents efficacy in treating inflammatory complications of the pouch after ileal pouch-anal anastomosis for ulcerative colitis.
Short-term and long-term remissions were evaluated at 8 weeks and 12 months, respectively.
|The rates of short-term clinical remission were 0.50|
|American Journal of Gastroenterology|
The team identified 21 articles and 3 abstracts including 313 patients treated either with infliximab or adalimumab for inflammatory complications of the pouch.
The rates of short-term and long-term clinical remission were 0.50, 0.57, and 0.52, respectively.
The researchers noted that the rate of remission after anti-tumor necrosis factors induction therapy seemed to be higher in Crohn’s disease-like complications of the pouch, compared to refractory pouchitis, whereas no such difference appeared after long-term maintenance therapy.
Sensitivity analyses suggested no difference in outcomes.
The research team detected no significant publication bias.
Dr Buisson's team comments, "Anti-tumor necrosis factors agents have a clear trend to have higher and faster efficacy in Crohn’s disease-like complications of the pouch compared to refractory pouchitis, highlighting the need to differentiate these 2 entities both in daily practice and clinical trials."