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Dermatological complications affect one in five IBD patients treated with anti-TNFs
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Dermatological complications affected more than 20% of patients with inflammatory bowel disease treated with anti-tumor necrosis factor agents, according to results from a 14-year study.
To determine the cumulative incidence of cutaneous adverse reactions induced by anti-tumor necrosis factor (TNF) agents in patients with IBD, as well as the management, outcomes and risk factors of these dermatological complications, Laurent Peyrin-Biroulet, MD, PhD, and colleagues performed a retrospective observational study of 583 consecutive adult patients (82.3% Crohn’s disease, 17.7% ulcerative colitis; 61% women; mean age, 24 ± 13 years at diagnosis, 34.6 ± 39.6 years at first anti-TNF treatment) followed at Nancy University Hospital in France.
Laurent Peyrin-Biroulet
All patients had their first anti-TNF treatment between 2000 and 2011, and follow-up was continued until June 2014 (median follow-up, 38.2 [1-179] months). A survival analysis was performed to ascertain the cumulative incidence of dermatological complications and associated risk factors.
Overall, 176 cutaneous adverse reactions occurred (30.8% incidence) in 20.5% of patients. Psoriasiform lesions occurred in 10.1% of all patients (88.1% with Crohn’s disease; 10-year cumulative incidence, 28.9%), leading to discontinuation of anti-TNF agents in 18.6% of cases. Among the 35.6% of patients with psoriasiform lesions who switched to another anti-TNF agent, 57% experienced recurrence.
Cutaneous infections occurred in 11.6% of all patients (10-year cumulative incidence, 17.6%), leading to discontinuation of anti-TNF agents in 2.9% of cases. Patients with ulcerative colitis had a lower risk for any dermatological complications compared with patients with Crohn’s disease (HR = 0.44; 95% CI, 0.27-0.51), and lower risk for cutaneous infections specifically (HR = 0.25; 95% CI, 0.09-0.68). There was an anti-TNF dose-dependent association with a higher risk for cutaneous infections (HR = 1.99; 95% CI, 1.09-3.64). Patients aged younger than 28 years at the time anti-TNF therapy was initiated had a higher risk for dermatological complications compared with patients aged older than 46 years (HR = 2.25; 95% CI, 1.39-3.62), for cutaneous infections specifically (HR = 2.66; 95% CI, 1.37-5.07), and for psoriasiform lesions specifically (HR = 5.11; 95% CI, 2.43-11.16).
“In conclusion, among a large cohort of anti-TNF-treated IBD patients in our academic center over a 14-year period, dermatological complications involve one out of five patients,” the researchers wrote. “Appropriate and early topical- and/or systemic-specific dermatological therapy can avoid anti-TNF discontinuation in half of patients.” Switching anti-TNF agents should be considered for psoriasiform lesions despite evidence of recurrence, and the dose-dependent relationship for cutaneous infections is a key finding of the study, they added. “Taken together, our findings could be used to guide decision making in anti–TNF-treated IBD patients developing skin lesions.” – by Adam Leitenberger
Disclosure: Peyrin-Biroulet reports financial relationships with AbbVie, Biogaran, Hospira and MSD. Please see the study for a full list of all other authors’ relevant financial disclosures.
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