Pyoderma gangrenosum and tumour necrosis factor alpha inhibitors: A semi‐systematic review

Abstract

Pyoderma gangrenosum (PG) is a rare ulcerative skin disease that presents a therapeutic challenge. Tumour necrosis factor alpha (TNFα) inhibitors have been reported to successfully control PG. Our aim was to systematically evaluate and compare the clinical effectiveness of TNFα inhibitors in adults with PG. A literature search including databases such as PubMed, Embase, Scopus, and Web of Science was conducted, using search terms related to PG and TNFα inhibitors. Studies and case reports were included if patients were diagnosed with PG, over the age of 18 and administered TNFα inhibitor. A total of 3212 unique citations were identified resulting in 222 articles describing 356 patients being included in our study. The study we report found an 87% (95% CI: 83%‐90%) response rate and a 67% (95% CI: 62%‐72%) complete response rate to TNFα inhibitors. No statistically significant differences in the response rates (P = 0.6159) or complete response rates (P = 0.0773) to infliximab, adalimumab, and etanercept were found. In our study TNFα inhibitors demonstrated significant effectiveness with response and complete response rates supporting the use of TNFα inhibitors to treat PG in adults. Our study suggests that there is no significant difference in effectiveness among infliximab, adalimumab, and etanercept.

Pyoderma gangrenosum associated with ulcerative colitis: A recalcitrant case responded to adalimumab with granulocyte and monocyte adsorption apheresis

“…The favorable outcome in our case was comparable with the prognosis of TNF-α inhibitor-naïve PG patients who later received ADA within 12 weeks of onset. 1,4 A few PG cases receiving two biologics have been described, mainly switching from IFX to ADA. 1,5 One of these patients received secondary ADA treatment in combination with cyclosporin and prednisolone, and the PG ulcer resolved within 16 weeks.…”

“…1,4 A few PG cases receiving two biologics have been described, mainly switching from IFX to ADA. 1,5 One of these patients received secondary ADA treatment in combination with cyclosporin and prednisolone, and the PG ulcer resolved within 16 weeks. 5 In our case, GCAP worked well with secondary ADA.…”

“…Yuki ISAMI, 1 Yuriko KAWASE, 1 Akari KONDO, 1 Wataru AKITA, 2 Koji YASUDA, 3 Takeshi MATSUTANI, 4 Hiroshi MITSUI 1…”

“…4,5 In this report, we presented two cases of refractory NP successfully treated with the CPBD gel, and suggest that gel formulation may be superior to ointment formulation in the treatment of NP. Hiroyuki TAKAMA, 1,2 Yoriko ANDO, 1 Takeshi YANAGISHITA, 1 Yuichiro OHSHIMA, 1 Masashi AKIYAMA, 2 Daisuke WATANABE 1 (Fig. 1g).…”

“…In 2016, Tan et al 1 reported an NP patient refractory to oral methotrexate who was successfully treated with CPBD gel. To our knowledge, this is the first case report of NP refractory to apremilast successfully treated with CPBD gel.…”