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- Title
Characteristics of Skin Lesions Associated With Anti-Tumor Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease: A Cohort Study.
- Authors
Cleynen, Isabelle; Van Moerkercke, Wouter; Billiet, Thomas; Vandecandelaere, Pieter; Casteele, Niels Vande; Breynaert, Christine; Ballet, Vera; Ferrante, Marc; Noman, Maja; Van Assche, Gert; Rutgeerts, Paul; van den Oord, Joost J.; Gils, Ann; Segaert, Siegfried; Vermeire, Séverine; Vande Casteele, Niels; Assche, Gert Van
- Abstract
<bold>Background: </bold>A subgroup of patients with inflammatory bowel disease (IBD) treated with anti-tumor necrosis factor (TNF) antibodies develop skin lesions, but the lesions and their clinical course are not well-characterized.<bold>Objective: </bold>To describe patients treated with anti-TNF antibodies who did and did not develop skin lesions.<bold>Design: </bold>Retrospective cohort.<bold>Setting: </bold>Single IBD tertiary referral center.<bold>Patients: </bold>917 consecutive patients with IBD who initiated anti-TNF therapy.<bold>Measurements: </bold>Skin lesions, patient demographic characteristics, treatments, clinical course, and serologic and genetic markers.<bold>Results: </bold>During a median follow-up of 3.5 years (interquartile range [IQR], 0.5 to 7.4 years), skin lesions associated with the use of anti-TNF therapy developed in 264 of 917 (29%) patients (psoriasiform eczema, 30.6%; eczema, 23.5%; xerosis cutis, 10.6%; palmoplantar pustulosis, 5.3%; psoriasis, 3.8%; other, 26.1%). Lesions typically developed at flexural regions, genitalia, and the scalp, especially the psoriasiform lesions. Thirty-one percent of women and 26% of men developed lesions. Median cumulative doses (2864 mg/y [IQR, 2203 to 3819 mg/y] and 2927 mg/y [IQR, 2377 to 3667 mg/y]) and trough levels (4.2 µg/mL [IQR, 2.6 to 5.8 µg/mL] and 4.0 µg/mL [IQR, 1.6 to 5.9 µg/mL]) of infliximab were similar in patients with and without lesions. All but 28 patients (11%) were successfully managed without needing to stop therapy because of lesions.<bold>Limitation: </bold>Retrospective nature and no matched control group of patients not receiving anti-TNF therapy.<bold>Conclusion: </bold>Skin lesions occur frequently in association with anti-TNF therapy but rarely require discontinuation of therapy. Close surveillance and early referral to a dedicated dermatologist are recommended.<bold>Primary Funding Source: </bold>Research Foundation Flanders (FWO), Belgium; Geconcerteerde Onderzoekacties of KU Leuven; and Janssen Biologics.
- Subjects
TUMOR necrosis factors; SKIN wound treatment; INFLAMMATORY bowel disease treatment; TREATMENT of eczema; DEMOGRAPHIC characteristics; SEROLOGY; DISEASE susceptibility; DRUG eruptions; ECZEMA; INFLAMMATORY bowel diseases; PSORIASIS; RETROSPECTIVE studies; CHEMICAL inhibitors
- Publication
Annals of Internal Medicine, 2016, Vol 164, Issue 1, p10
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M15-0729