Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China.
Inflamm Bowel Dis. 2012 Dec;18(12):2232-9. doi: 10.1002/ibd.22933. Epub 2012 Mar 8.
Crohn's disease (CD) of the pouch can develop in patients with ileal pouch-anal anastomosis, resulting in significant morbidities, even pouch failure. The aim of this study was to evaluate short- and long-term outcome of adalimumab (ADA) in treating these patients.
A total of 48 patients who received ADA for CD of the pouch from June 2006 to June 2011 were identified from our prospectively maintained Pouchitis Registry Complete clinical response was defined as the resolution of symptoms as well as the modified Pouchitis Disease Activity Index (mPDAI) score being less than 5. Partial clinical response was defined as improvement in symptoms as well as a reduction in mPDAI score of 2 or more. Endoscopic mucosal healing status before and after therapy was recorded.
At a short follow-up of median 8 weeks, 24 (50%) patients had complete response, 10 (21%) had partial response, and 14 (29%) had no response. After a median follow-up of 25.1 months, 16 (33%) patients had a complete response, 10 (21%) had a partial response, and 22 (46%) had no response. At the end of the follow-up, 13 (27%) patients achieved mucosal healing. A total of nine (19%) patients eventually developed pouch failure. Patients with a long-term response had a significantly higher mucosal healing rate (60.9% vs. 28.6%, P = 0.032) and significantly lower median mPDAI score (2.0 vs. 5.0, P = 0.004) at the first follow-up evaluation than those with no long-term response. Multivariate analysis showed concurrent endoscopic stricture dilation (hazard ratio = 5.9; 95% confidence interval: 1.6, 21.2) increased the chance for the long-term response to ADA. One patient developed multiple sclerosis during the therapy.
ADA treatment, particularly in conjunction with endoscopic therapy, may help rescue a subgroup of patients with CD of the pouch from having surgery.
回肠贮袋肛门吻合术后患者可能会发生贮袋克罗恩病，导致严重的并发症，甚至贮袋功能丧失。本研究旨在评估阿达木单抗（ADA）治疗此类患者的短期和长期疗效。
从我们前瞻性维持的贮袋炎登记处中，确定了 2006 年 6 月至 2011 年 6 月期间因贮袋克罗恩病而接受 ADA 治疗的 48 例患者。完全临床缓解定义为症状缓解，改良贮袋炎疾病活动指数（mPDAI）评分＜5。部分临床缓解定义为症状改善，mPDAI 评分降低≥2。记录治疗前后内镜下黏膜愈合情况。
在 8 周的短期随访中，24 例（50%）患者完全缓解，10 例（21%）患者部分缓解，14 例（29%）患者无反应。在 25.1 个月的中位随访后，16 例（33%）患者完全缓解，10 例（21%）患者部分缓解，22 例（46%）患者无反应。随访结束时，13 例（27%）患者达到黏膜愈合。共有 9 例（19%）患者最终发生贮袋功能丧失。长期缓解的患者黏膜愈合率显著更高（60.9% vs. 28.6%，P=0.032），首次随访时 mPDAI 评分中位数显著更低（2.0 vs. 5.0，P=0.004）。多变量分析显示，同期内镜下狭窄扩张（风险比=5.9；95%置信区间：1.6，21.2）增加了 ADA 长期缓解的机会。1 例患者在治疗期间发生多发性硬化。
ADA 治疗，特别是联合内镜治疗，可能有助于使一部分贮袋克罗恩病患者免于手术。
