Induction of psoriasis with anti-TNF agents in patients with inflammatory bowel disease: A report of 21 cases

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• 作者：Ivá ; n Guerra^a ; ^{ivan.guerra@salud.madrid.org} ; Alicia Algaba^a ; José ; Lá ; zaro Pé ; rez-Calle^b ; Mar&iacute ; a Chaparro^c ; Ignacio Mar&iacute ; n-Jimé ; nez^d ; Raquel Garc&iacute ; a-Castellanos^e ; Yago Gonzá ; lez-Lama^f ; Antonio Ló ; pez-Sanromá ; n^g ; Noem&iacute ; Manceñ ; ido^h ; Pilar Mart&iacute ; nez-Montielⁱ ; Elvira Quintanilla^j ; Carlos Taxonera^k ; Mó ; nica Villafruela^l ; Alberto Romero-Maté ; ^m ; Pilar Ló ; pez-Serrano^b ; Javier P. Gisbert^c ; Fernando Bermejo^a
• 关键词：ADA ; Adalimumab ; CD ; Crohn's disease ; CI ; confidence interval ; IBD ; inflammatory bowel disease ; IFX ; infliximab ; TNF ; tumor necrosis factor ; UC ; ulcerative colitis
• 刊名：Journal of Crohn's and Colitis
• 出版年：2012
• 期刊代码：pca215_18739946
• 类别：med
• 出版时间：June, 2012
• 卷：6
• 期：5
• 页码：518-523
• 文件大小：260 K

摘要

Aim

Anti-tumor necrosis factor (TNF)-alpha agents are widely used for the treatment of both inflammatory bowel disease (IBD) and psoriasis. Psoriatic skin lesions induced by anti-TNF have been described in patients with IBD. We report a case series of psoriasis induced by anti-TNF agents in IBD patients.

Methods

Systematic analysis of cases of psoriasis induced by anti-TNF in an IBD patient cohort in tertiary hospitals of Madrid.

Results

A total of 21 of 1294 patients with IBD treated with anti-TNF-alpha agents developed drug-induced psoriasis (cumulative incidence 1.62%; 95%CI 1.06%-2.47%): 14 patients with infliximab and 7 with adalimumab; seventeen with Crohn's disease, 4 with ulcerative colitis. The onset of skin lesions varied in a wide range of time (after a mean 13 卤 8 doses). The most frequent site of skin lesions was the limbs (62%) followed by the trunk (48%) and the scalp (43%). The psoriasis phenotypes were plaque psoriasis (57%), scalp (14%), palmoplantar pustulosis (14%), pustular generalized psoriasis (5%), guttate (5%) and inverse (5%). Four patients interrupted the anti-TNF treatment, and that led to the complete regression of lesions in 1 of them. The other 17 patients were maintained on anti-TNF therapy and managed with topical steroids.

Conclusion

Psoriatic lesions can be induced by anti-TNF drugs. Plaque psoriasis on the extremities and trunk were the most frequent presentations in our series. Topical steroid treatment is effective in most patients. Anti-TNF discontinuance may be reserved for patients with severe psoriasis or patients without response to topical therapy.