英夫利昔单抗治疗与炎症性肠病相关的坏疽性脓皮病。

Infliximab for treatment of pyoderma gangrenosum associated with inflammatory bowel disease.

作者信息

Regueiro Miguel, Valentine John, Plevy Scott, Fleisher Mark R, Lichtenstein Gary R

机构信息

University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 19104-4283, USA.

出版信息

Am J Gastroenterol. 2003 Aug;98(8):1821-6. doi: 10.1111/j.1572-0241.2003.07581.x.

DOI:10.1111/j.1572-0241.2003.07581.x

PMID:12907338

Abstract

OBJECTIVES

Pyoderma gangrenosum is an immune-mediated inflammatory condition characterized by ulcerative skin lesions affecting 1-2% of patients with inflammatory bowel disease (IBD). Treatment includes wound care, antibiotics, corticosteroids, and immunomodulators. However, response to therapy varies, and many patients with pyoderma gangrenosum have disease that is refractory to these agents. The aim of this study was to assess the response of medically refractory pyoderma gangrenosum to infliximab.

METHODS

This was a multicenter retrospective study of patients with IBD and medically refractory pyoderma gangrenosum treated with infliximab. Data collected included the following: baseline demographics; duration of IBD; history of bowel resection; duration of skin lesions; number, size, and location of pyoderma gangrenosum lesions; prior medications; dose and number of infliximab infusions; bowel activity before and after infliximab; pyoderma gangrenosum activity before and after infliximab therapy; time to response and time to healing of pyoderma gangrenosum lesions; recurrence of pyoderma gangrenosum after infliximab; corticosteroid taper; and adverse reactions to infliximab.

RESULTS

There were 13 patients with moderate to severe pyoderma gangrenosum and IBD treated with infliximab. All patients demonstrated complete healing of the skin lesions. Three patients had a complete response to induction infliximab therapy and did not require additional treatment. Ten patients responded to induction infliximab and have maintained pyoderma gangrenosum healing with infusions every 4-12 wk. All patients receiving corticosteroids were able to discontinue them completely after institution of infliximab treatment. Infliximab was well tolerated; the only treatment-related adverse events were sunburn in one patient and an infusion reaction in another.

CONCLUSIONS

Infliximab is a safe and effective treatment for IBD-associated pyoderma gangrenosum.

摘要

目的

坏疽性脓皮病是一种免疫介导的炎症性疾病，其特征为溃疡性皮肤病变，在1%-2%的炎症性肠病（IBD）患者中出现。治疗包括伤口护理、抗生素、皮质类固醇和免疫调节剂。然而，治疗反应各不相同，许多坏疽性脓皮病患者对这些药物难治。本研究的目的是评估英夫利昔单抗对药物难治性坏疽性脓皮病的反应。

方法

这是一项对接受英夫利昔单抗治疗的IBD和药物难治性坏疽性脓皮病患者的多中心回顾性研究。收集的数据包括以下内容：基线人口统计学资料；IBD病程；肠道切除史；皮肤病变持续时间；坏疽性脓皮病病变的数量、大小和位置；既往用药情况；英夫利昔单抗输注的剂量和次数；英夫利昔单抗治疗前后的肠道活动情况；英夫利昔单抗治疗前后的坏疽性脓皮病活动情况；坏疽性脓皮病病变的反应时间和愈合时间；英夫利昔单抗治疗后坏疽性脓皮病的复发情况；皮质类固醇减量情况；以及对英夫利昔单抗的不良反应。

结果

有13例中度至重度坏疽性脓皮病和IBD患者接受了英夫利昔单抗治疗。所有患者的皮肤病变均完全愈合。3例患者对诱导性英夫利昔单抗治疗完全缓解，无需额外治疗。10例患者对诱导性英夫利昔单抗有反应，并通过每4-12周输注一次维持坏疽性脓皮病愈合。所有接受皮质类固醇治疗的患者在开始英夫利昔单抗治疗后均能够完全停用。英夫利昔单抗耐受性良好；仅有的与治疗相关的不良事件是1例患者出现晒伤，另1例患者出现输液反应。