Severe Skin Lesions Cause Patients With Inflammatory Bowel Disease to Discontinue Anti–Tumor Necrosis Factor Therapy

Abstract

BACKGROUND & AIMS:Psoriasiform and eczematiform lesions are associated with anti-tumor necrosis factor (TNF)-α therapies. We assessed clinical characteristics, risk factors, and outcomes of skin disease in patients with inflammatory bowel diseases that presented with psoriasiform and eczematiform lesions induced by anti-TNF-α agents. METHODS: We studied 85 patients (69 with Crohn's disease, 15 with ulcerative colitis, and 1 with indeterminate colitis; 62 women) with inflammatory skin lesions (62 psoriasiform and 23 eczematiform lesions). RESULTS: Twenty-four patients had a history of inflammatory skin lesions and 15 had a familial history of inflammatory skin disease. Locations of eczematiform lesions varied whereas scalp and flexural varieties were mostly psoriasiform. Skin lesions emerged but inflammatory bowel disease was quiescent in 69 patients following treatment with any type of anti-TNF-α agent (60 with infliximab, 20 with adalimumab, and 5 with certolizumab). Topical therapy resulted in partial or total remission in 41 patients. Patients with psoriasiform lesions that were resistant to topical therapy and that changed anti-TNF-α therapies once or twice developed recurring lesions. Overall, uncontrolled skin lesions caused 29 patients to stop taking TNF-α inhibitors. CONCLUSIONS: Inflammatory skin lesions following therapy with TNF-α inhibitors occurred most frequently among women and patients with a personal or familial history of inflammatory skin disease; lesions did not correlate with intestinal disease activity. Recurring and intense skin lesions caused 34% of patients in this study to discontinue use of anti-TNF-α agents.

Long‐term safety and efficacy of certolizumab pegol in the treatment of Crohn's disease: 7‐year results from the PRECiSE 3 study

“…28 TNF antagonists have been implicated in new or worsening psoriasis when used to treat inflammatory bowel disease 29,30 ; few cases were reported during this 7-year study.…”

The onset of psoriasis during the treatment of inflammatory bowel diseases with infliximab: should biological therapy be suspended?

“…According to the present review, 69 cases (1-3, 5, 7-9, 11, 12, 15-18, 21-23, 25-31, 33-36, 38-44) of psoriasis induced or exacerbated by infliximab were reported in IBD patients. Some studies (10,13,24,32,37,45) did not participate in this descriptive analysis because it was not possible to extract data on IBD patients only under infliximab therapy and/or because they did not contain information on such patients' clinical development.…”

“…With this regard, there is disagreement in the literature as to the need to suspend biological therapy in order to achieve complete resolution of these cutaneous lesions (psoriasis), specifically in IBD patients. Some authors (6,14) agree to its withdrawal while others (10,32,37) report that the biological must be maintained. Due to risk for IBD deterioration after suspension of the TNF-α inhibitory molecule, the authors of the present study aimed at presenting a systematic literathe onset of psorIasIs durIng the treatment of Inflammatory bowel dIseases wIth InflIxImab: should biological therapy be suspended?…”

“…It has been efficient in the treatment of inflammatory bowel diseases (IBD) for more than a decade (20) ; however, since 2004, the number of paradoxical cases of psoriasis induced or exacerbated by infliximab described in IBD patients have increased (6,10,14,32,37) , since TNF-α inhibition determines therapeutic benefits in psoriasis (4) . With this regard, there is disagreement in the literature as to the need to suspend biological therapy in order to achieve complete resolution of these cutaneous lesions (psoriasis), specifically in IBD patients.…”

Paradoxical Inflammation in IBD Patients Treated with Anti-Tumor Necrosis Factor Alpha Therapy

“…The switch to a second and third TNF antagonist is usually not effective. In a retrospective 19/62 patients with psoriatic skin lesions induced by TNF antagonists were switched to another TNF antagonist with improvement in one patient only [61]. Two patients were also switched unsuccessfully to a third TNF antagonist.…”