Infliximab Paradoxical Psoriasis in a Cohort of Children With Inflammatory Bowel Disease

Courbette, Olivier; Aupiais, Camille; Viala, Jérôme; Hugot, Jean‐Pierre; Louveau, Baptiste; Chatenoud, Lucienne; Bourrat, E.; Martinez-Vinson, Christine

doi:10.1097/mpg.0000000000002349

Cited by 26 publications

(28 citation statements)

References 36 publications

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“…There are significant differences in the incidence of psoriasis in the different genders in the pediatric group (7-17 years) treated with IFX [46]. And in most cohort studies of pediatric patients, TNF antagonist induced psoriasis is more predisposed to the female population [18,48]. In our study, OR Teenager group is higher than OR Adult group in the analysis of the association between different gender groups.…”

Section: Discussionmentioning

confidence: 46%

A systematic review and meta-analysis: Female smokers,even former smokers lead higher incidence of psoriasis in the treatment of inflammatory bowel disease with biological agents.

Yang¹,

Liu²,

Deng

et al. 2020

Preprint

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Background: At present, infliximab(IFX) and adalimumab(ADA) are the classic drugs for the treatment of moderate-severe inflammatory bowel disease(IBD), which prove effective for the disease control. However, the side effects need to be monitored during the therapy process, especially the paradoxical reaction of the skin system such as psoriasis, which could greatly benefit quality of patients’ life.Aim: In order to describe and analyze TNF-antagonist-induced psoriasis in patients with inflammatory bowel disease from the aspects of incidence, pathogenesis, distribution and type of lesions, prognosis and treatment, the incidence of psoriasis induced by Infliximab (IBD) and Adalimumab (ADA) in the treatment of Inflammatory Bowel Disease Disease (IBD) as well as the relationship between sex, smoking and the incidence of psoriasis were investigated.Methods: Literatures in English language meeting the qualifications on Pubmeb, Embase, Web of Science, Google, and Geenmedical databases were searched . More than two co-authors evaluated the quality of the article and extracted the data respectively. The data obtained were statistically analyzed by statistical software of Revman and Stata.Results: 1) The incidence of psoriasis was higher in ADA Group (OR 0.66, P<0.05, 95% CI (0.52-0.84) ; 2) The incidence of psoriasis was higher in females than in males (OR 1.54, P<0.05, 95% CI (1.27-1.86)) ; 3) Smoking increased the incidence of psoriasis (OR 1.79, P<0.01, 95% CI (1.42-2.24); 4) Psoriasis is mainly distributed in the Scalp, Palmoplantar, skin folds and limbs, and often occurs in the genital organs, the pathogenesis of which is not completely clear; the interval of medication is more than one year, and the interval of medication using IFX is longer than that of ADA Group; most cases can be relieved by local hormone, phototherapy or systemic hormone therapy without changing the strategy of biological agents.Conclusion: The incidence of psoriasis induced by TNF-antagonists is higher in many autoimmune diseases. The frequency of reported in inflammatory bowel disease is higher than other autoimmune diseases, and the safety of ADA Treatment for IBD is higher than that of IFX The incidence of psoriasis is higher in women than in men; the incidence of psoriasis is significantly higher in smokers / ex-smokers than in non-smokers. The interval of drug use of TNF-antagonists may be a predictive factor for the prevention and treatment of psoriasis, and there are differences among different kinds of TNF-antagonists. Change of therapeutic strategy of TNF-antagonists is not recommended in the event of psoriasis.

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Section: Discussionmentioning

confidence: 46%

A systematic review and meta-analysis: Female smokers,even former smokers lead higher incidence of psoriasis in the treatment of inflammatory bowel disease with biological agents.

Yang¹,

Liu²,

Deng

et al. 2020

Preprint

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“…In this data-mining study of adverse events of TNF-α inhibitors in pediatric patients based on the nationwide Danish population, we found no signals of previously unknown adverse events. A signal of dermatologic complications that has been previously described in adults and children was detected, including excess cases of diseases of the skin and subcutaneous tissue, and dermatitis and eczema [21][22][23][24][25][26]. A detected signal of psychiatric diagnoses of anxiety, dissociative, stress-related, somatoform, and other nonpsychotic mental disorders, including reaction to severe stress and adjustment disorders, was likely associated with the underlying disease and its severity, rather than with the treatment.…”

Section: Discussionmentioning

confidence: 73%

Data Mining for Adverse Events of Tumor Necrosis Factor-Alpha Inhibitors in Pediatric Patients: Tree-Based Scan Statistic Analyses of Danish Nationwide Health Data

et al. 2020

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Background and Objectives Tumor necrosis factor-alpha (TNF-α) inhibitors are efficacious and considered generally safe in adults. However, pediatric-specific safety evidence is scarce. The aim of this study was to screen for signals of previously unknown adverse events of TNF-α inhibitors in pediatric patients. Methods We conducted a data-mining study based on routinely collected, nationwide Danish healthcare data for 2004-2016. Using tree-based scan statistics to identify events with unexpectedly high incidence during TNF-α inhibitor use among patients with inflammatory bowel disease or juvenile idiopathic arthritis, two analyses were performed: comparison with episodes of no use and with other time periods from the same patient. Based on incident physician-assigned diagnosis codes from outpatient and inpatient visits in specialist care, we screened thousands of potential adverse events while adjusting for multiple testing. Results We identified 1310 episodes of new TNF-α inhibitor use that met the eligibility criteria. Two signals of adverse events of TNF-α inhibitors, as compared with no use, were detected. First, there were excess events of dermatologic complications (ICD-10: L00-L99, 87 vs. 44 events, risk difference [RD] 3.3%), which have been described previously in adults and children. Second, there were excess events of psychiatric diagnosis adjustment disorders (ICD-10: F432, 33 vs. 7 events, RD 2.0%), which was likely associated with the underlying disease and its severity, rather than with the treatment. The selfcontrolled analysis generated no signal. Conclusions No signals of previously unknown adverse events of TNF-α inhibitors in pediatric patients were detected. The study showed that real-world data and newly developed methods for adverse events data mining can play a particularly important role in pediatrics where pre-approval drug safety data are scarce.

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“…In one retrospective study, Courbette et al highlighted that the median time of paradoxical psoriasis appearance in children treated with Infliximab was after the eighth infection which corresponded to 355 days (from the moment of treatment initiation). In this study, psoriasis occurred in CD patients only, and it was associated with perianal lesions suggesting that perianal lesions represent a risk factor for psoriasis in CD patients [ 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…Also, it seems that polymorphism in the IL-23R gene may have a role in the development of paradoxical infliximab-induced psoriasis. The association between psoriasis and perianal lesions in CD patients has not been established but it seems that they share a cutaneous immune response [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Dermatological Manifestations in Pediatric Inflammatory Bowel Disease

et al. 2020

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Background and Objectives: Over the last years, inflammatory bowel disease (IBD) has been reported on a high incidence in pediatric populations and has been associated with numerous extraintestinal manifestations, making its management a real challenge for the pediatric gastroenterologist. Dermatological manifestations in IBD are either specific, related to the disease activity or treatment-associated, or non-specific. This literature review aims to identify and report the dermatological manifestations of IBD in children, the correlation between their appearance and the demographical characteristics, the relationship between these lesions and disease activity, and to highlight the impact of dermatological manifestations on an IBD treatment regime. Materials and Methods: A systemic literature review was performed, investigating articles and case reports on dermatological manifestations in children with IBD starting from 2005. A total of 159 potentially suitable articles were identified and after the exclusion process, 75 articles were selected. Results: The most common dermatological manifestations reported in pediatric IBD are erythema nodosum and pyoderma gangrenosum. More rare cases of metastatic Crohn’s disease, epidermolysis bullosa acquisita, small-vessel vasculitis, necrotizing vasculitis, leukocytoclastic vasculitis, cutaneous polyarteritis nodosa, and Sweet’s syndrome have been reported. Oral manifestations of IBD are divided into specific (tag-like lesions, mucogingivitis, lip swelling with vertical fissures, aphthous stomatitis, and pyostomatitis vegetans) and non-specific. IBD treatment may present with side effects involving the skin and mucosa. Anti-tumor necrosis factor agents have been linked to opportunistic skin infections, psoriasiform lesions, and a potentially increased risk for skin cancer. Cutaneous manifestations such as acrodermatitis enteropathica, purpuric lesions, and angular cheilitis may appear secondary to malnutrition and/or malabsorption. Conclusions: The correct diagnosis of dermatological manifestations in pediatric IBD is of paramount importance because of their impact on disease activity, treatment options, and a patient’s psychological status.

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Infliximab Paradoxical Psoriasis in a Cohort of Children With Inflammatory Bowel Disease

Cited by 26 publications

References 36 publications

A systematic review and meta-analysis: Female smokers,even former smokers lead higher incidence of psoriasis in the treatment of inflammatory bowel disease with biological agents.

A systematic review and meta-analysis: Female smokers,even former smokers lead higher incidence of psoriasis in the treatment of inflammatory bowel disease with biological agents.

Data Mining for Adverse Events of Tumor Necrosis Factor-Alpha Inhibitors in Pediatric Patients: Tree-Based Scan Statistic Analyses of Danish Nationwide Health Data

Dermatological Manifestations in Pediatric Inflammatory Bowel Disease

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