Department of Pediatric Gastroenterology, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Crohns Colitis. 2022 Sep 8;16(9):1420-1427. doi: 10.1093/ecco-jcc/jjac055.
Anti-tumour necrosis factor [anti-TNF] induced skin reactions are common adverse events in paediatric inflammatory bowel disease [IBD]. We aimed to report on outcomes of children with anti-TNF induced skin reactions who switched to ustekinumab [UST] vs. continued anti-TNF therapy.
Charts were reviewed for paediatric IBD patients with anti-TNF induced skin reactions. Skin reactions, including psoriasiform dermatitis [PD], were classified as mild or severe based on a severity score. Primary outcome was frequency of skin resolution at 6 months. Secondary outcomes were combined clinical remission and skin resolution at 6 months and skin resolution at latest follow-up.
A total of 111/638 [17%] children ([85, 21%] infliximab [IFX]; [26, 11%] adalimumab [ADA]) developed skin reactions. Eighty [72%] had PD, 25 [23%] infections, and four [4%] alopecia areata; 71 [64%] continued anti-TNF; and 40 [36%] switched to UST. In all, 73 [66%] had severe reactions and were more likely to switch to UST than if mild (37 [51%] vs. 3 [8%]; p <0.0001). Switching to UST had a higher rate and odds of resolution (29 [73%] vs. 24 [34%]; p <0.0001; odds ratio [OR] = 19.7, 95% confidence interval [CI]: 5.6, 69.5; p <0.0001) and combined remission (21 [52%] vs. 22 [31%]; p = 0.03; OR = 8.5, 95% CI: 2.5, 28.4; p = 0.0005] vs. continuing anti-TNF at 6 months.
Children who switched to UST after anti-TNF induced skin reactions were more likely to have improved outcomes than those who continued anti-TNF therapy. Future studies are needed to determine immune mechanisms of anti-TNF induced skin reactions and treatment response.
抗肿瘤坏死因子[抗 TNF]诱导的皮肤反应是小儿炎症性肠病[IBD]的常见不良事件。我们旨在报告接受英夫利昔单抗[IFX]或阿达木单抗[ADA]治疗后发生抗 TNF 诱导皮肤反应的儿童换用乌司奴单抗[UST]与继续抗 TNF 治疗的结局。
回顾分析发生抗 TNF 诱导皮肤反应的小儿 IBD 患者的病历。皮肤反应，包括银屑病样皮炎[PD]，根据严重程度评分分为轻度或重度。主要结局为 6 个月时皮肤缓解的频率。次要结局为 6 个月时联合临床缓解和皮肤缓解，以及最新随访时的皮肤缓解。
共 111/638 例（[85，21%]IFX；[26，11%]ADA）患儿发生皮肤反应。80 例（72%）为 PD，25 例（23%）为感染，4 例（4%）为斑秃；71 例（64%）继续抗 TNF 治疗，40 例（36%）换用 UST。总体而言，73 例（66%）为重度反应，更倾向于换用 UST 治疗（37 例[51%] vs. 3 例[8%]；p <0.0001）。换用 UST 治疗的缓解率和缓解可能性更高（29 例[73%] vs. 24 例[34%]；p <0.0001；优势比[OR] = 19.7，95%置信区间[CI]：5.6，69.5；p <0.0001），联合缓解率也更高（21 例[52%] vs. 22 例[31%]；p = 0.03；OR = 8.5，95% CI：2.5，28.4；p = 0.0005）。
抗 TNF 诱导皮肤反应后换用 UST 的患儿较继续抗 TNF 治疗的患儿结局改善更明显。未来需要进一步研究以明确抗 TNF 诱导皮肤反应和治疗反应的免疫机制。
