Is biologic therapy effective for antibiotic-refractory pouchitis?

Main text introduction The use of biologic therapy for antibiotic-refractory pouchitis is controversial, due to few studies on the subject and lack of convincing results. Objectives To study the efficacy of biologic therapy for refractory pouchitis. Materials and methods In this retrospective study, patient records at the Medical and Surgical departments in our hospital during an eleven-year period were scrutinized. 25 patients treated with biologics for refractory pouchitis were identified. Results The majority of these patients (n = 19, 76%) had either good or partial effect of biologic therapy for refractory pouchitis. Six of these patients did not respond until the second or third-line treatment. All naive patients (n = 14) had good or partial response regardless if the diagnosis was idiopathic or Crohn's-like pouchitis. In comparison, only 45% (n = 5) of the patients with prior exposure to biologics (n = 11) had a positive response. Six of ten patients treated with second or third-line therapy had a good or partial response. All not naive patients who had previously been treated with Infliximab (n = 9) had adverse reactions when the same drug was given for pouchitis. Conclusions This retrospective study suggests that biologic therapy may be effective for both idiopathic and Crohn's-like refractory pouchitis. Naive patients seem to respond more successfully than not naive patients. In cases without response on first-line treatment should second-line treatment be considered. Due to the high risk of adverse reactions Infliximab should be avoided to not naive patients.