S1221 Risankizumab Sustains Remission and Improves Anti-TNF-Induced Psoriasiform Dermatitis in Well Controlled Crohn's Disease Patients Switched From Anti-TNF Therapy
Notice bibliographique
Résumé
Introduction: Paradoxical anti-tumor necrosis factor (TNF)-induced psoriasiform dermatitis (PD) continues to limit treatment durability, with eczema history increasing of PD. Switching to anti-IL-12/23 is effective in some, with emerging evidence for use of anti-IL-4 targets. The efficacy of risankizumab (RZB) for anti-TNF-induced PD in Crohn’s Disease remains unknown. Methods: A single center retrospective chart review identified CD patients with anti-TNF-induced PD switched from TNF to RZB between June 2022 and November 2023. Patients not in steroid free clinical remission (SFCR) at the time of switch or with < 12 weeks of RZB at last follow-up were excluded. TNF-induced-PD was scored as resolved, mild or severe. The primary outcome was sustained SFCR and PD resolution on RZB at last follow-up. Secondary outcomes included frequency of PD improvement and PD resolution. Descriptive statistics summarized the data (Median [IQR] or frequencies) and univariate tested associations. Results: Twenty-one patients with TNF-induced-PD switched from anti-TNF (infliximab 71%, adalimumab 24%, golimumab 5%) to RZB; 13(62%) female; Median [IQR] age: 33 [21-38] years, disease duration 9 [6-17] years, time from anti-TNF initiation to development of PD 46.9 [23.2-83.7] months, time from developing PD to starting RZB 11.5 [4.5-50.7] months (Table 1). Seventeen (81%) PD reactions were classified as severe. Scalp, ears, and trunk were most frequently affected areas (38%, 33%, 33% respectively), with 81% of patients having >1 affected region. Six (29%) had either a personal and/or family history of eczema. All patients were on topical therapy and 1 was on oral antibiotics for their PD at RZB switch. At last follow-up (257 [160-365] days on RZB), all 20 patients remaining on RZB sustained SFCR and had complete resolution (N=11,55%) or improvement in PD (n=9, 45%). Patients not achieving PD resolution had numerically shorter exposure to RZB at follow-up (173 vs 314 days), severe skin reaction at baseline (50% vs 25% mild) and higher reported eczema history (67% vs 36%). One patient stopped RZB secondary to joint pain, returning to anti-TNF with recurrence of their PD, and subsequently switched to upadacitinib with resolution. Conclusion: In patients with anti-TNF-induced PD, RZB significantly improves PD and maintains disease control. Eczema is an important risk factor for developing PD and may impact PD outcomes. IL-4 targeted therapies may be a more biology driven approach to anti-TNF induced PD. Table 1. - Patient Population Baseline characteristics Total (n=21) Age: Median [IQR] years 33 [21-38] Female n (%) 13 (62) Disease duration, Median [IQR] years 9 (6-17) Location L1: Ileal n (%) 4 (19) Location L2: Colonic n (%) 3 (14) Location L3: Ileocolonic n (%) 14 (67) Behavior B1 Inflammatory n (%) 16 (76) Behavior B2 Stricturing n (%) 1 (5) Behavior B3 Penetrating n (%) 3 (14) Behavior B2B3 n (%) 1 (5) Perianal involvement n (%) 6 (29) Small bowel surgery history n (%) 3 (15) Therapy Exposure Prior UST Exposure n (%) 2 (10) Anti-TNF Immediately Prior to RZB Infliximab/Adalimumab/Golimumab 15 (71) / 5 (24) / 1 (5) Escalated (vs labeled) TNF dosing 12 (57) Psoriasiform Dermatitis (PD) at RZB start Personal history of eczema n (%) 5 (24) Family history of eczema/psoriasis n(%) 6 (29) Time from TNF to PD, months; Median [IQR] 46.9 [23.2-83.7] Time from PD to RZB, months; Median [IQR] 11.5 [4.5-50.7] Skin location Scalp n (%) 8 (38) Ears/Post auricular n (%) 7 (33) Trunk n (%) 7 (33) Face n (%) 6 (29) Arms/Legs n (%) 4 (19) Axilla n (%) 2 (10) Umbilicus n (%) 2 (10) Severity of skin change Mild n (%) 4 (19) Severe n (%) 17 (81) UST: Ustekinumab; PD: Psoriasiform dermatitis.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| 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) | 0,001 | 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 source (Gemma direct ou Codex distillé), 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 ».