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Anti-Tumor Necrosis Factor-α-Induced Dermatological Complications in a Large Cohort of Inflammatory Bowel Disease Patients

Digestive Diseases and Sciences volume 63, pages 746–754 (2018)Cite this article

Abstract

Background/Aims

The broader use of anti-tumor necrosis factor (TNF) agents in inflammatory bowel disease (IBD) has been associated with a high rate of adverse reactions. Dermatological complications are among the most common adverse events. We assessed the incidence, risk factors, management, and outcome of anti-TNF-induced dermatological complications in a large cohort of IBD patients.

Methods

This was an observational retrospective study at a single tertiary referral center. All consecutive adult IBD patients treated with anti-TNF agents between 2005 and 2015 were identified. Patients who developed at least one dermatological complication while on anti-TNF therapy were included.

Results

From the 732 patients treated with anti-TNF agents, 211 (29%) developed at least one dermatological complication: 52% women (mean age of 42 ± 13 years), 85% with Crohn’s disease, 67% were under infliximab. Median follow-up time under anti-TNF therapy was 53 (27–77) months. Dermatological complications recorded were: infections (13.5%), psoriasiform lesions (5.3%), injection/infusion reactions (3.8%), skin cancer (0.5%), and miscellaneous (5.6%). Overall, female gender (OR = 1.658, p = 0.029), smoking (OR = 2.021, p = 0.003), and treatment with an infliximab dose of 10 mg/kg (OR = 2.012, p = 0.007) were independent risk factors for dermatological complications in multivariable analysis. Female gender (OR = 3.63, p = 0.017), smoking (OR = 2.846, p = 0.041), and treatment with adalimumab (OR = 8.894, p < 0.001) were independently associated with development of psoriasiform lesions. Three (3%) patients with infectious complications and 12 (31%) patients with psoriasiform lesions discontinued anti-TNF therapy definitively.

Conclusions

Dermatological manifestations occurred in almost one-third of our population. Infections were the most common complication, but anti-TNF-induced psoriasiform lesions were the most common cause for anti-TNF therapy definitive discontinuation.

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Funding

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Authors and Affiliations

  1. Gastroenterology Department, Centro Hospitalar São João, University of Porto Medical School, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal

    P. Andrade, S. Lopes, R. Gaspar, A. Nunes & G. Macedo

  2. Dermatology Department, Centro Hospitalar São João, University of Porto Medical School, Porto, Portugal

    S. Magina

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  1. P. Andrade
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  2. S. Lopes
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  3. R. Gaspar
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  4. A. Nunes
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Contributions

PA and SL were responsible for study design. PA and RG were responsible for data collection. PA and RG were responsible for statistical analyses. PA and SL wrote the manuscript. SM, AN, and GM revised and approved the final manuscript. All the named authors, contributing directly to the work described, have agreed on the respective roles of each author, read the manuscript, and approved submission.

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Correspondence to P. Andrade.

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Conference Presentation

24th United European Gastroenterology Week 2016. Vienna, October 15–19, 2016.

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Andrade, P., Lopes, S., Gaspar, R. et al. Anti-Tumor Necrosis Factor-α-Induced Dermatological Complications in a Large Cohort of Inflammatory Bowel Disease Patients. Dig Dis Sci 63, 746–754 (2018). https://doi.org/10.1007/s10620-018-4921-y

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  • DOI: https://doi.org/10.1007/s10620-018-4921-y

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