Cumulative Incidence of, Risk Factors for, and Outcome of Dermatological Complications of Anti-TNF Therapy in Inflammatory Bowel Disease: A 14-Year Experience

Fréling, E.; Baumann, Cédric; Cuny, J.-F.; Bigard, Marc‐André; Schmutz, J.‐L.; Barbaud, A.; Peyrin–Biroulet, Laurent

doi:10.1038/ajg.2015.205

Cited by 113 publications

(140 citation statements)

References 46 publications

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“…Recurrence of psoriasiform lesions after switch to a second anti‐TNF‐ α agent ranged from 20 to 100% of cases. However, reports with a higher number of patients attempting a switch show a rate of recurrence in around 60% of cases …”

Section: Resultsmentioning

confidence: 97%

“…Although some studies showed a higher time until onset of lesions with infliximab, more recently, Guerra et al . (2016) showed no significant differences in clinical latency between different anti‐TNF‐ α agents.…”

Section: Discussionmentioning

confidence: 98%

“…For this reason, it is not consensual if another anti‐TNF‐ α should be attempted or a different therapeutic class should be considered. A wide range of recurrence rates after a second anti‐TNF‐ α agent was observed in different studies . In spite of an important risk of recurrence, two of the included studies recommended a switch to a second anti‐TNF‐ α drug.…”

Section: Discussionmentioning

confidence: 99%

“…Probably one of the most important findings of this review that has been consistently reported in many studies is the association of the onset of dermatological reactions with periods of IBD remission. Around 88–93% of patients had quiescent or mild disease activity at the time of psoriasis development, as attested by low levels of fecal calprotectin (FC) and low PGA (Physician's Global Assessment) or other activity markers (C‐reactive protein and albumin) …”

Section: Discussionmentioning

confidence: 99%

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Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Melo

Magina

2018

Int J Dermatology

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Tumor necrosis factor alpha inhibitors (anti-TNF-α) completely revolutionized the treatment of inflammatory bowel disease (IBD). However, anti-TNF-α-induced cutaneous side effects have been increasingly reported in the literature. Particularly, psoriasis and the recently recognized psoriasiform lesions are of particular concern, as anti-TNF-α agents are also used in the treatment of psoriasis, seemingly reflecting an immunological paradox. The clinical management of these cutaneous lesions is particularly challenging, owing to the potential need of anti-TNF-α discontinuation and scarcity of other therapeutic options. Therefore, optimization of current topical and systemic therapies and incorporation of new therapeutic agents is of great interest. Our aim is to review data in the literature regarding the clinical management of these cutaneous lesions and provide a therapeutic algorithm, supported by our experience as a tertiary referral center for IBD. Although in older reports no distinction was made, anti-TNF-α-induced psoriasiform lesions are not only more prevalent but also bear notable differences from classical psoriasis, possibly reflecting a different nosological entity. Onset of lesions has been related to periods of IBD remission, as supported by low levels of fecal calprotectin. Psoriasiform lesions can be adequately managed either by topical (glucocorticoids, calcineurin inhibitors, and antibiotics) or systemic (phototherapy, acitretin, glucocorticoids, and antibiotics) therapies and/or switch to other anti-TNF-α agents. Data referring to patients who were able to continue on the same IBD therapy ranged from 30.7 to 100%, reinforcing the importance of an adequate control of these lesions. The recently approved ustekinumab offers another step in the management of anti-TNF-α-intolerant patients.

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Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Melo

Magina

2018

Int J Dermatology

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“…One of the most common adverse effects of these therapies, seen in up to 25% of rheumatological patients receiving anti‐TNF‐α agents, has been reported as paradoxical cutaneous manifestations that may harbor a wide spectrum of clinical aspects, including paradoxical psoriasis . Inflammatory bowel disease (IBD) cohorts have shown similar rates of paradoxical manifestations . These cutaneous side‐effects may be worrisome enough to contraindicate the anti‐TNF‐α agent class and lead to a therapeutic dead end .…”

Section: Introductionmentioning

confidence: 99%

Ustekinumab for skin reactions associated with anti‐tumor necrosis factor‐α agents in patients with inflammatory bowel diseases: A single‐center retrospective study

Ezzedine

Cadiot

Brixi

et al. 2019

The Journal of Dermatology

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Anti‐tumor necrosis factor (TNF)‐α agents may induce skin reactions, in particular in patients with inflammatory bowel diseases (IBD). The objective of this study was to determine the efficacy of ustekinumab in these patients. IBD patients facing therapeutic issues because of cutaneous reactions or tolerance issues, consequently treated with ustekinumab in our department, were included. Retrospective review of case records and clinical photographs was carried out. Twenty‐six patients were included. Twenty‐three patients were treated for Crohn's disease and three for ulcerative colitis. Fourteen patients presented psoriasiform lesions, nine eczematiform lesions, four anaphylactoid reactions, two alopecia areata‐like lesions, one injection‐site reaction, one cutaneous polyarteritis nodosa and five other skin reactions. Most of them resolved under ustekinumab. In detail, eczematiform lesions completely resolved in all cases, psoriasiform lesions completely resolved in 12 cases (85.7%) and had partial response in two cases (14.3%). Two cases of alopecia areata showed complete response (complete hair regrowth). Fourteen patients showed complete digestive response, 10 patients partial digestive response (seven of which needed IBD treatment optimization) and only two failure. In conclusion, ustekinumab is a drug of choice in patients with IBD who cannot tolerate TNF blockers.

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Psoriasis Associated With Tumor Necrosis Factor Inhibitors in Children With Inflammatory Diseases

Buckley

Xiao

Perman

et al. 2021

Arthritis Care & Research

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Objective To estimate the incidence rate (IR) of psoriasis in children with inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), and chronic noninfectious osteomyelitis (CNO) with tumor necrosis factor inhibitor (TNFi) exposure as compared to children without TNFi exposure and to the general pediatric population. Methods This was a single‐center retrospective cohort study of children with IBD, JIA, or CNO from 2008 to 2018. TNFi exposure was defined as a prescription for adalimumab, etanercept, infliximab, certolizumab, or golimumab, and the primary outcome was incident psoriasis. IRs and standardized incidence ratios (SIRs) were calculated. Cox proportional hazards models were used to assess the association of psoriasis with TNFi exposure and other risk factors. Results Of the 4,111 children who met inclusion criteria, 1,614 (39%) had TNFi exposure and 2,497 (61%) did not, with 4,705 and 6,604 person‐years of follow‐up, respectively. There were 58 cases (IR 12.3 per 1,000 person‐years) and 25 cases (IR 3.8 per 1,000 person‐years) of psoriasis in children with and without TNFi exposure, respectively. The SIR was 18 (95% confidence interval [95% CI] 15–22) overall, 30 (95% CI 23–39) for children with TNFi exposure, and 9.3 (95% CI 6.3–14) for children without TNFi exposure. The hazard ratio of psoriasis comparing TNFi exposure to no TNFi exposure was 3.84 (95% CI 2.28–6.47; P < 0.001). Conclusion Children with IBD, JIA, and CNO had an increased rate of psoriasis compared to the general pediatric population, with the highest rate in those with TNFi exposure.

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Cumulative Incidence of, Risk Factors for, and Outcome of Dermatological Complications of Anti-TNF Therapy in Inflammatory Bowel Disease: A 14-Year Experience

Cited by 113 publications

References 46 publications

Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Ustekinumab for skin reactions associated with anti‐tumor necrosis factor‐α agents in patients with inflammatory bowel diseases: A single‐center retrospective study

Psoriasis Associated With Tumor Necrosis Factor Inhibitors in Children With Inflammatory Diseases

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