Leukocytoclastic Vasculitis Related to Ustekinumab in a Crohn’s Disease Patient: First Case Report and Literature Review

Costa-Moreira, Pedro; Lopes, Susana; Santos, Ana Luísa; Pedrosa, Ana; Andrade, Patrícia; Portugal, Raquel; Macedo, Guilherme

doi:10.1093/ecco-jcc/jjz128

Cited by 16 publications

(13 citation statements)

References 22 publications

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“…Real world data from the ENEIDA registry, the GETAID cohort and a US population were consistent with the known safety profile of UST (77)(78)(79). Three cases of leukocytoclastic vasculitis related to UST have been reported (79,95,96). To date, there are no data on safety for Risankizumab, Brazikumab and Guselkumab in UC.…”

Section: Anti-il23 P19supporting

confidence: 54%

The IL23-IL17 Immune Axis in the Treatment of Ulcerative Colitis: Successes, Defeats, and Ongoing Challenges

et al. 2021

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Ulcerative colitis (UC) is a chronic relapsing disorder of the colonic tract, characterized by a dysregulated innate and adaptive immune response to gut microbiota that contributes to the perpetuation of intestinal inflammatory processes. The Interleukin (IL) 23/IL17 axis has been reported to play a key role in UC pathogenesis promoting Th17 cells and cytokines-related immune response. Recently, the blockade of IL23/IL17 pathways has been raised enormous interest in the treatment o several chronic inflammatory disorders. In this review, we summarize the emerging results from clinical trials that evoked both promise and discouragement in IL23/IL17 axis in the treatment of UC. Targeting IL23 p40 through Ustekinumab results safe and effective to induce and maintain clinical remission, low inflammatory indexes, mucosal healing, and a better quality of life. Studies targeting IL23 p19 through Mirikizumab, Risankizumab, Brazikumab and Guselkumab are still ongoing. To date, no clinical studies targeting IL17 pathway are ongoing in UC. IL-17 targeting is thought to have a context-dependent biological effect, based on whether cytokine is selectively targeted or if its function is dampened by the upstream block of IL23.

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Section: Anti-il23 P19supporting

confidence: 54%

The IL23-IL17 Immune Axis in the Treatment of Ulcerative Colitis: Successes, Defeats, and Ongoing Challenges

et al. 2021

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“…These included the development of a Mycobacterium abscessus soft tissue infection, 24 malignant melanoma in a patient with dysplastic nevus syndrome, 25 and leukocytoclastic vasculitis. 26 In a long-term efficacy and safety study of ustekinumab for Crohn's disease, ustekinumab was found to have a favorable safety profile, comparable to that of placebo. Injection site reactions were low, and no serious opportunistic infections were recorded during the extension period.…”

Section: Discussionmentioning

confidence: 99%

Ustekinumab for the treatment of paradoxical skin reactions and cutaneous manifestations of inflammatory bowel diseases

Smogorzewski

2021

Dermatologic Therapy

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Ustekinumab (STELARA), a human monoclonal antibody directed against IL‐12 and IL‐23, is FDA‐approved to treat psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. Increasing recognition of paradoxical skin reactions induced by older biologic therapies used for inflammatory bowel diseases (IBD), such as, adalimumab and infliximab, has led to the investigation of ustekinumab for the treatment of the cutaneous and gastrointestinal manifestations of IBD. In addition, ustekinumab may show efficacy in treating paradoxical cutaneous reactions to tumor necrosis factor‐alpha (TNF‐α) inhibitors. A search of the Medline/PubMed database, with additional citations obtained from the references section of relevant articles, yielded 22 articles that were included in this review. Ustekinumab is a safe and effective option for treating the cutaneous manifestations of IBD, such as, metastatic Crohn's disease and pyoderma gangrenosum. It is also an effective treatment for TNF‐α inhibitor‐induced paradoxical skin reactions, such as, psoriasis that do not remit spontaneously or with conventional treatment. Additional studies should focus on the optimal dosing of ustekinumab for dermatologic conditions beyond psoriasis.

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“…The majority of the patients in this review developed LCV as reactive manifestation of UC (95%), and only one patient (5%) developed LCV as a consequence of anti-tumor necrosis factor (TNF-alfa) therapy [12]. This finding is strikingly different from patients with LCV and CD, where LCV attributed to IBD therapy (most commonly infliximab and adalimumab) was found in 60% of patients [8,41]. In one of the cases, a streptococcal infection preceded both rash occurrence and UC symptoms.…”

Section: Discussionmentioning

confidence: 76%

Clinical Manifestations of Leukocytoclastic Vasculitis, Treatment, and Outcome in Patients with Ulcerative Colitis: A Systematic Review of the Literature

Pantic

Jevtic

Nordstrom

et al. 2022

JCM

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Leukocytoclastic vasculitis (LCV) is a rare extraintestinal manifestation (EIM) of ulcerative colitis (UC). Observations about its association with UC stem from case reports and small case series. Due to its rarity, more rigorous cross-sectional studies are scarce and difficult to conduct. The aim of this systematic review was to synthetize the knowledge on this association by reviewing published literature in the form of both case reports and case series; and report the findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In contrast to LCV in Chron disease (CD), which occurs secondary to biologic therapies used for its treatment, LCV in UC is a true reactive skin manifestation. Both genders are equally affected. Palpable purpura (41%) and erythematous plaques (27%) are the most common clinical manifestations. In 41% of patients, the rash is painful, and the lower extremities are most commonly involved (73%). Systemic symptoms such as fever, arthralgias, fatigue, and malaise are seen in 60% of patients. Unlike previous reports, we found that LCV more commonly occurs after the UC diagnosis (59%), and 68% of patients have active intestinal disease at the time of LCV diagnosis. Antineutrophil cytoplasmic antibody (ANCA) is positive in 41% of patients, and 36% of patients have other EIMs present concomitantly with LCV. The majority of patients were treated with corticosteroids (77%), and two (10%) required colectomy to control UC and LCV symptoms. Aside from one patient who died from unrelated causes, all others survived with their rash typically resolving without scarring (82%).

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Leukocytoclastic Vasculitis Related to Ustekinumab in a Crohn’s Disease Patient: First Case Report and Literature Review

Cited by 16 publications

References 22 publications

The IL23-IL17 Immune Axis in the Treatment of Ulcerative Colitis: Successes, Defeats, and Ongoing Challenges

The IL23-IL17 Immune Axis in the Treatment of Ulcerative Colitis: Successes, Defeats, and Ongoing Challenges

Ustekinumab for the treatment of paradoxical skin reactions and cutaneous manifestations of inflammatory bowel diseases

Clinical Manifestations of Leukocytoclastic Vasculitis, Treatment, and Outcome in Patients with Ulcerative Colitis: A Systematic Review of the Literature

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