Dermatological Reactions Associated With Anti-TNF Therapy in Inflammatory Bowel Disease: A Single-Centre, 13-Year Experience
Notice bibliographique
Résumé
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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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,002 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».