Dermatological Reactions Associated With Anti-TNF Therapy in Inflammatory Bowel Disease: A Single-Centre, 13-Year Experience

Introduction: Anti-TNF therapies are amongst our most effective therapies to induce and maintain remission in patients with inflammatory bowel disease (IBD). They are, however, not without side effects. Data on dermatological complications are limited. We describe the incidence, management and outcome of dermatological reactions associated with anti-TNF therapy in IBD patients at our centre. Methods: We conducted a retrospective review of 501 IBD patients treated with anti-TNF (Infliximab or Adalimumab) therapy between 2005-2018. Data was collected from electronic and paper-based case records and included disease demographics, clinical history, treatment and dermatological reactions Results: Fifty-four patients (10.7%) had dermatological reactions, 34 were female(63%). Forty two patients had Crohn's disease (CD=78%) and 12 had ulcerative colitis (UC =22.%). Montreal phenotype in CD was A2(30) L3(22) B1(25) and 7/10 UC patients had E3 disease. Mean age at diagnosis was 34.3 years (median 28, IQR 23.5) Thirty-eight patients were treated with Infliximab(IFX). A non-specific rash was noted in 14 patients, eczema in 10 and psoriasiform reactions in 9 patients.Six patients had shingles and urticaria, itching and acne were seen in 3 patients each. Seborrheic dermatitis, cellulitis and skin abscesses were noted in 2 patients each and 2 patients had Lichen planus and chicken pox. The average time of onset from treatment to symptoms was 20 months (median 7,IQR 27). In 20/ 38 patients treated with IFX, the dermatological reaction was mild, allowing continuation of treatment, 16 were switched to adalimumab (ADA) of which 3 patients had a recurrence (Psoriasis, itching and acne) leading to cessation of anti-TNF therapy and switch to Ustekinumab. One patient had no further biological treatment and another patient was switched to ustekinumab. Of 16 patients who had ADA, 13 continued treatment, 2 were switched to ustekinumab without any further reaction and in 1 patient no further biologic was administered. Conclusion: Ten percent of our anti-TNF treated patients had dermatological reaction. We did not observe a “class effect” after switching to a different anti TNF. Dermatological reactions were more common in colonic CD and with infliximab. Further studies on cumulative dermatological effects, risk factors, time to event and outcomes are underway at our institution.

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