Outcomes of Children with Inflammatory Bowel Disease who Develop Anti-tumour Necrosis Factor-induced Skin Reactions
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Published on: September 12, 2019
Michael T Dolinger1, Priya Rolfes2, Elizabeth Spencer1
1Department of Pediatric Gastroenterology, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Children with anti-tumour necrosis factor [anti-TNF] induced skin reactions in inflammatory bowel disease [IBD] who switched to ustekinumab [UST] showed better outcomes than those continuing anti-TNF therapy. This highlights ustekinumab as a potential treatment option for managing these adverse skin reactions.
Area of Science:
- Pediatric Gastroenterology
- Dermatology
- Immunology
Background:
- Anti-tumour necrosis factor [anti-TNF] therapies are widely used for paediatric inflammatory bowel disease [IBD].
- Skin reactions are a common adverse event associated with anti-TNF therapy in children with IBD.
- Psoriasiform dermatitis [PD] is a frequent type of anti-TNF induced skin reaction.
Purpose of the Study:
- To compare the outcomes of paediatric IBD patients who switched to ustekinumab [UST] versus those who continued anti-TNF therapy after developing skin reactions.
- To evaluate the efficacy of ustekinumab in resolving anti-TNF induced skin reactions and achieving clinical remission.
Main Methods:
- Retrospective chart review of paediatric IBD patients experiencing anti-TNF induced skin reactions.
- Classification of skin reactions as mild or severe using a standardized severity score.
- Primary endpoint: frequency of skin reaction resolution at 6 months; secondary endpoints: combined clinical remission and skin resolution, and skin resolution at latest follow-up.
Main Results:
- 17% of paediatric IBD patients developed skin reactions, most commonly PD.
- Patients with severe skin reactions were more likely to switch to ustekinumab.
- Switching to ustekinumab resulted in significantly higher rates of skin reaction resolution and combined clinical remission compared to continuing anti-TNF therapy.
Conclusions:
- Ustekinumab is an effective treatment option for paediatric IBD patients experiencing anti-TNF induced skin reactions.
- Children switching to ustekinumab demonstrated improved skin reaction resolution and clinical remission rates.
- Further research is warranted to elucidate the immunological mechanisms underlying these reactions and treatment responses.
Background And Aims:
Anti-tumour necrosis factor [anti-TNF] induced skin reactions are common adverse events in paediatric inflammatory bowel disease [IBD]. We aimed to report on outcomes of children with anti-TNF induced skin reactions who switched to ustekinumab [UST] vs. continued anti-TNF therapy.
Methods:
Charts were reviewed for paediatric IBD patients with anti-TNF induced skin reactions. Skin reactions, including psoriasiform dermatitis [PD], were classified as mild or severe based on a severity score. Primary outcome was frequency of skin resolution at 6 months. Secondary outcomes were combined clinical remission and skin resolution at 6 months and skin resolution at latest follow-up.
Results:
A total of 111/638 [17%] children ([85, 21%] infliximab [IFX]; [26, 11%] adalimumab [ADA]) developed skin reactions. Eighty [72%] had PD, 25 [23%] infections, and four [4%] alopecia areata; 71 [64%] continued anti-TNF; and 40 [36%] switched to UST. In all, 73 [66%] had severe reactions and were more likely to switch to UST than if mild (37 [51%] vs. 3 [8%]; p <0.0001). Switching to UST had a higher rate and odds of resolution (29 [73%] vs. 24 [34%]; p <0.0001; odds ratio [OR] = 19.7, 95% confidence interval [CI]: 5.6, 69.5; p <0.0001) and combined remission (21 [52%] vs. 22 [31%]; p = 0.03; OR = 8.5, 95% CI: 2.5, 28.4; p = 0.0005] vs. continuing anti-TNF at 6 months.
Conclusions:
Children who switched to UST after anti-TNF induced skin reactions were more likely to have improved outcomes than those who continued anti-TNF therapy. Future studies are needed to determine immune mechanisms of anti-TNF induced skin reactions and treatment response.
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