S1221 Risankizumab Sustains Remission and Improves Anti-TNF-Induced Psoriasiform Dermatitis in Well Controlled Crohn's Disease Patients Switched From Anti-TNF Therapy
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".