Adalimumab in the treatment of chronic pouchitis. A randomized double-blind, placebo-controlled trial.

Background: Pouchitis is a complication of ileal pouch-anal anastomosis and occurs in up to 50% of patients 10 years after IPAA with 10% developing refractory pouchitis.Objective: To evaluate the effect of a TNF- inhibitor (Adalimumab) in the treatment of refractory pouchitis.Materials and methods: A multicenter, randomized double-blind, placebo-controlled trial includes patients with refractory pouchitis for more than 4 weeks despite antibiotic treatment. Patients were randomized to Adalimumab or placebo for 12 weeks. Primary outcome was reduction in clinical pouchitis disease activity index (PDAI) of 2 at any time. Secondary endpoints were remission of pouchitis, endoscopic and histologic effect and quality of life.Results: Thirteen patients were included; six patients received active treatment and seven patients received placebo. Nine patients (5/4, Adalimumab/placebo) completed the 12-week program. Reduction in clinical PDAI 2 was achieved in three patients in each group (50%/43%, Adalimumab/placebo, p>.5). Total PDAI improved in six patients treated with Adalimumab and two patients on placebo (100%/29%, p=.13). There were no differences in secondary endpoints between the groups.Conclusions: In this randomized controlled trial of treatment with Adalimumab in patients with refractory pouchitis, we were not able to identify any clinical benefit in the primary or secondary endpoints.