International collaborative experiences in managing pyoderma gangrenosum in patients with inflammatory bowel disease

Pyoderma gangrenosum (PG) is a rare but challenging extraintestinal manifestation (EIM) of inflammatory bowel diseases (IBD), affecting 6%-48% of IBD patients. This retrospective study analyzed affected patients and evaluated therapeutic strategies for both IBD remission and PG resolution. A multicenter retrospective analysis was conducted on patients with IBD and PG in eight tertiary IBD centers. Demographic data, prior therapies, surgeries, and treatment of PG were collected retrospectively, and treatment responses were assessed. The cohort included 50 patients (median age: 43 years; 68% female). Crohn's disease was present in 58% and ulcerative colitis in 42%. Fifty percent of patients had prior surgery, 68% had an intestinal stoma in their medical history. 48% were experienced with biologic therapy, predominantly anti-tumor necrosis factor (TNF) therapy (83%). PG mainly affected the lower extremities (52%) and peristomal areas (24%). Systemic steroids were used in 52% (26/50) and led to PG resolution in only 11.5% (3/26). Anti-TNF therapy was the main approach, used in 68% (34/50) of patients, with resolution achieved in 80% (27/34). Calcineurin inhibitors were given to 26% (13/50) of patients and induced resolution in 38% (5/13). Three of six non-responders were successfully switched to infliximab. Overall, PG resolution was achieved in 80% (40/50), correlating with IBD remission in 78% (31/40) of these patients. The median time to PG resolution was 4 months. Anti-TNF therapy was an effective treatment for PG in IBD patients, even in those with prior nonresponse to calcineurin inhibitors. Systemic steroids showed low response rates. PG healing mostly aligned with IBD remission, underlining the need for tailored long-term therapy.