Yanai Henit, Amir Barak Hadar, Ollech Jacob E, Avni Biron Irit, Goren Idan, Snir Yifat, Banai Eran Hagar, Broitman Yelena, Aharoni Golan Maya, Didkovsky Elena, Amitay-Laish Iris, Ollech Ayelet, Hodak Emmilia, Dotan Iris, Pavlovsky Lev
IBD Center, Division of Gastroenterology, Rabin Medical Center, 39 Zeev Jabutinsky Road, Beilinson Campus, Petah Tikva 49100, Israel.
IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.
Therap Adv Gastroenterol. 2021 Nov 8;14:17562848211053112. doi: 10.1177/17562848211053112. eCollection 2021.
Skin eruptions are prevalent among patients with inflammatory bowel diseases (IBD), often associated with therapies and frequently leading to dermatological consults and treatment interruptions. We aimed to assess the impact of joint shared decision-making in a multidisciplinary (MDT) IBD-DERMA clinic.
This retrospective cohort study assessed a consecutive group of patients with IBD who were referred for consultation in an MDT clinic at a tertiary referral center in Israel.
Over 1 year, 118 patients were evaluated in the MDT-IBD-DERMA clinic: 68 (57.6%) males; age - 35.2 ± 13.5 years, disease duration - 7.1 (interquartile range: 3.7-13.9) years; Crohn's disease - 94/118 (79.6%). Skin eruption induced by an anti-tumor necrosis factor (TNF) were the most common diagnoses [46/118 (39%)], including psoriasiform dermatitis (PD) - 31/46 (67.4%) and inflammatory alopecia (IA) - 15/46 (32.6%). Of these, 18 patients (39.1%) continued the anti-TNF agent concomitantly with a topical or systemic anti-inflammatory agent to control the eruption. The remaining 28 patients (60.9%) discontinued the anti-TNF, of whom 16/28 (57.1%) switched to ustekinumab. These strategies effectively treated the majority [38/46 (82.6%)] of patients. Continuation of the anti-TNF was possible in a significantly higher proportion of patients with PD: 12/31 (38.7%) than only one in the IA group, = 0.035. There was a higher switch to ustekinumab among the IA 7/15 (46.6%) compared with the PD 7/31 (22.6%) group, = .09. Following IBD-DERMA advised intervention, IBD deteriorated in 9/4 6(19.5%) patients, 5/9 on ustekinumab (PD IA, = NS).
Shared decision-making in an integrated IBD-DERMA clinic allowed successful control of skin eruptions while preserving control of the underlying IBD in more than 80% of cases. Patients with IA profited from a switch to ustekinumab.
皮肤疹在炎症性肠病（IBD）患者中很常见，常与治疗相关，且频繁导致皮肤科会诊和治疗中断。我们旨在评估多学科（MDT）IBD - DERMA诊所中共同决策的影响。
这项回顾性队列研究评估了在以色列一家三级转诊中心的MDT诊所接受会诊的一组连续的IBD患者。
在1年多的时间里，MDT - IBD - DERMA诊所评估了118例患者：男性68例（57.6%）；年龄 - 35.2 ± 13.5岁，病程 - 7.1（四分位间距：3.7 - 13.9）年；克罗恩病 - 94/118（79.6%）。由抗肿瘤坏死因子（TNF）诱导的皮肤疹是最常见的诊断[46/118（39%）]，包括银屑病样皮炎（PD） - 31/46（67.4%）和炎症性脱发（IA） - 15/46（32.6%）。其中，18例患者（39.1%）继续使用抗TNF药物并联合局部或全身抗炎药来控制皮疹。其余28例患者（60.9%）停用了抗TNF，其中16/28（57.1%）改用乌司奴单抗。这些策略有效治疗了大多数[38/46（82.6%）]患者。PD患者中继续使用抗TNF的比例明显高于IA组，分别为12/31（38.7%）和1/15（6.7%），P = 0.035。IA组改用乌司奴单抗的比例高于PD组，分别为7/15（46.6%）和7/31（22.6%），P = 0.09。在IBD - DERMA建议的干预措施后，9/46（19.5%）患者的IBD病情恶化，其中5/9使用乌司奴单抗（PD + IA，P = 无显著性差异）。
在综合的IBD - DERMA诊所中共同决策能够成功控制皮肤疹，同时在超过80%的病例中维持对基础IBD的控制。IA患者从改用乌司奴单抗中获益。
