Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Prague, Czech Republic.
Eur J Pediatr. 2021 Sep;180(9):3001-3008. doi: 10.1007/s00431-021-04077-0. Epub 2021 Apr 19.
Studies showing a substantial frequency of dermatologic complications in paediatric Crohn's disease (CD) patients on anti-tumour necrosis factor (TNF) therapy preferentially include patients treated with infliximab. We aimed to identify risk factors for the cumulative incidence of skin complications in a paediatric cohort receiving either adalimumab or infliximab and found an association between current skin complications and the patient's current clinical condition. This study retrospectively evaluated dermatologic complications in an inception cohort of 100 paediatric CD patients receiving the first anti-TNF (Motol PIBD cohort). Patient data were collected every 3 months. The lesions were classified as psoriatic, atopic dermatitis, or others. We used Cox regression to evaluate the association between predefined variables and the time to complication and a generalised linear mixed model to assess the association between the patient's current condition and the occurrence of complications. Among the 89 included children, 35 (39%) presented with dermatologic lesions. The only predictor associated with any complication was infliximab (versus adalimumab) therapy (hazard ratio [HR]: 2.07; 95% confidence interval [CI]: 1.03-4.17; p = 0.04). Infliximab therapy (HR: 5.5; 95%CI: 1.59-19.06; p = 0.01) and a family history of atopy (HR: 3.4; 95%CI 1.35-8.57, p = 0.002) were associated with early manifestation of atopic dermatitis. Lower C-reactive protein levels (odds ratio [OR], 0.947; 95% CI, - 0.898 to 0.998; p = 0.046) and infliximab (versus adalimumab) were associated with the occurrence of any dermatologic complications (OR, 5.93; 95% CI, 1.59-22.07; p = 0.008).Conclusion: The frequency of skin complications seems high in paediatric CD patients treated with anti-TNF and is even higher in those treated with infliximab. What is Known: •The dermatologic complications occur during treatment with anti-tumour necrosis factor. •The frequency of skin complications in paediatric patients with Crohn's disease is high. What is New: •Infliximab (vs. adalimumab) was identified as a strong risk factor for the cumulative incidence of skin complications. •Lower C-reactive protein levels were associated with the current occurrence of dermatologic complications.
研究表明，接受抗肿瘤坏死因子（TNF）治疗的小儿克罗恩病（CD）患者中，皮肤科并发症的发生率相当高，这些患者主要接受英夫利昔单抗治疗。我们旨在确定在接受阿达木单抗或英夫利昔单抗治疗的儿科患者队列中，皮肤并发症累积发生率的风险因素，并发现当前皮肤并发症与患者当前临床状况之间存在关联。本研究回顾性评估了接受首剂抗 TNF 治疗的 100 例小儿 CD 患者（Motol PIBD 队列）的皮肤科并发症。每 3 个月收集一次患者数据。病变分为银屑病、特应性皮炎或其他。我们使用 Cox 回归评估预定义变量与并发症时间之间的关联，使用广义线性混合模型评估患者当前状况与并发症发生之间的关联。在纳入的 89 例儿童中，35 例（39%）出现了皮肤病变。唯一与任何并发症相关的预测因素是英夫利昔单抗（而非阿达木单抗）治疗（风险比 [HR]：2.07；95%置信区间 [CI]：1.03-4.17；p = 0.04）。英夫利昔单抗治疗（HR：5.5；95%CI：1.59-19.06；p = 0.01）和特应性家族史（HR：3.4；95%CI 1.35-8.57，p = 0.002）与特应性皮炎的早期表现相关。较低的 C 反应蛋白水平（比值比 [OR]，0.947；95%CI，-0.898 至 0.998；p = 0.046）和英夫利昔单抗（而非阿达木单抗）与任何皮肤科并发症的发生相关（OR，5.93；95%CI，1.59-22.07；p = 0.008）。结论：接受抗 TNF 治疗的小儿 CD 患者的皮肤并发症发生率似乎较高，而接受英夫利昔单抗治疗的患者发生率更高。已知的：• 抗肿瘤坏死因子治疗期间会发生皮肤并发症。• 患有克罗恩病的儿科患者的皮肤并发症发生率很高。新的：• 英夫利昔单抗（与阿达木单抗相比）被确定为皮肤并发症累积发生率的一个强危险因素。• 较低的 C 反应蛋白水平与当前皮肤并发症的发生有关。
