How to Manage Inflammatory Bowel Disease Patients When They Withdraw Anti-Tumour Necrosis Factor [Anti-TNF] Due to Severe Anti-TNF-Induced Skin Lesions? A Multicentre Cohort Study.

Cottron, Clémentine;Treton, Xavier;Altwegg, Romain;Reenaers, Catherine;Laharie, David;et.al.
(2022) Journal of Crohn’s & colitis — Vol. 16, n° 8, p. 1202-1210 (2022)

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Authors
  • Cottron, Clémentine
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  • Treton, Xavier
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  • Altwegg, Romain
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  • Reenaers, Catherineorcid-logo
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  • Dewit, OlivierUCLouvain
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  • Laharie, David
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Abstract
BACKGROUND AND AIMS: Optimal management of patients with inflammatory bowel disease [IBD] after anti-tumour necrosis factor [TNF] discontinuation due to severe induced skin lesions is unclear. Our study aimed to describe dermatological and IBD evolution after anti-TNF discontinuation for this side effect. METHODS: We conducted a multicentre retrospective study including consecutive IBD patients who discontinued anti-TNF due to severe induced skin lesions. Our objectives were to determine factors associated with dermatological remission [complete disappearance of skin lesions] and with IBD relapse in patients with inactive disease at inclusion, notably the impact of an early switch to another biological agent within 3 months of anti-TNF discontinuation. RESULTS: Among the 181 patients [134 women, 160 Crohn's disease] included in the 13 participating centres, dermatological remission occurred in 110 [62%] patients with a median [interquartile range, IQR] interval of 8.0 [6.8-11.0] months. Scalp location was independently associated with less remission of skin lesions (hazard ratio [HR] = 0.64 [95% CI 0.43-0.94], p = 0.02) while early switch was independently associated with a higher probability of remission of skin lesions (HR = 1.64 [95% CI 1.1-2.5], p = 0.02). Among the 148 patients with inactive IBD at inclusion, disease relapse occurred in 75 [51%] patients with a median [IQR] interval of 26.0 [23.0-39.1] months. Survival rates without IBD relapse at 1 year were 85.8% [95% CI 77.5-94.9] in the early switch group and 59.3% [95% CI 48.9-71.9] in the other group [p < 0.01]. CONCLUSIONS: Early switch to a new biological is associated with a higher probability of healing of anti-TNF-induced skin lesions and significantly reduces the risk of IBD relapse.
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Cottron, C., Treton, X., Altwegg, R., Reenaers, C., Amiot, A., Fumery, M., Vuitton, L., Peyrin-Biroulet, L., Bouguen, G., Dewit, O., Nancey, S., Caillo, L., Roblin, X., Beylot-Barry, M., Rivière, P., & Laharie, D. (2022). How to Manage Inflammatory Bowel Disease Patients When They Withdraw Anti-Tumour Necrosis Factor [Anti-TNF] Due to Severe Anti-TNF-Induced Skin Lesions? A Multicentre Cohort Study. Journal of Crohn’s & colitis, 16(8), 1202-1210. https://doi.org/10.1093/ecco-jcc/jjac035 (Original work published 2022)