Dual‐targeted therapy with apremilast and vedolizumab in pyoderma gangrenosum associated with Crohn’s disease

Vernero, Marta; Ribaldone, Davide Giuseppe; Cariti, Caterina; Ribero, Simone; Susca, Sara; Astegiano, Marco; Dapavo, Paolo

doi:10.1111/1346-8138.15283

Cited by 10 publications

(7 citation statements)

References 5 publications

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“… 16 Infliximab-Tumor Necrosis Factor (TNF) antagonists have shown a more remarkable improvement for PG. 17 , 18 Other biologics, such as Tocilizumab, 19 Ustekinumab, 20 Vedolizumab, 21 anakinra, canakinumab, 22 and small-molecule drugs, including tofacitinib 23 and apremilast, 24 have been reported to be effective in some small sample cases.…”

Section: Discussionmentioning

confidence: 99%

Multiple Lesions at Different Stages of Pyoderma Gangrenosum in a Crohn’s Disease Patient

Zhang¹,

Sun²,

Li³

et al. 2022

CCID

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Pyoderma gangrenosum (PG) is an inflammatory dermatosis characterized by the rapid progression of a painful, necrolytic ulcer with an irregular and undermined border. The prevalence of PG in patients with Crohn’s disease (CD) has been estimated to be 0.7%. Here, we report a case that presented various painful skin lesions, including erythema, vesicles, plaques, and ulcers, one week before the fourth infliximab infusion for CD. PG was diagnosed and the lesions subsided after a 390-mg ustekinumab infusion for one month. It suggests that different lesions of PG may occur concomitantly in CD patients, and the therapy should be re-evaluated on time.

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Section: Discussionmentioning

confidence: 99%

Multiple Lesions at Different Stages of Pyoderma Gangrenosum in a Crohn’s Disease Patient

Zhang¹,

Sun²,

Li³

et al. 2022

CCID

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“…Our patient required careful follow-up when he was on remission maintenance therapy. When a patient experiences a relapse, novel antibody formulations, such as vedolizumab, which is effective for PG associated with CD, and ustekinumab, which has been reported to improve inflammatory cutaneous lesions, are expected to be effective (16,17).…”

Section: Discussionmentioning

confidence: 99%

Rapidly Progressing Aseptic Abscesses in a Patient with Ulcerative Colitis

Yamaguchi

Nakagawa

et al. 2021

Intern. Med.

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Aseptic abscesses (AAs) are extraintestinal manifestations of inflammatory bowel disease (IBD). IBDassociated AAs are rare in Japan. We treated a 45-year-old man with ulcerative colitis (UC)-associated AAs. During remission, multiple progressive abscesses were detected in the spleen; he underwent splenectomy because an infectious disease was suspected. Although his condition improved temporarily after splenectomy, a large liver abscess was noted, and a diagnosis of UC-associated AAs was made. Granulocytapheresis (GCAP) and infliximab (IFX) administration resolved the abscess. This is the first reported case of UC-associated AAs in a Japanese patient treated by splenectomy, GCAP, and IFX.

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“…41,42,47,55,57,68,69,70,72,75,81,84,87,91,93 Furthermore, studies that investigated changes in known cytokine cascades suggest that apremilast and PDE-4 inhibition may achieve its efficacy by targeting inflammatory mediators unaffected or not primarily affected by current first-line agents. [36][37][38][39][40]42,43,46,49,54,55,58,59,65,66,[81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96] In addition to efficacy, consideration should be given to apremilast's safety profile. While gastrointestinal TEAEs (most commonly nausea, diarrhea, vomiting), weight loss and headache do occur, they are often transient or manageable with dose modification.…”

Section: Additional Dermatosesmentioning

confidence: 99%

Apremilast as an Off-Label Therapeutic Agent

Marson

Lebwohl

2021

J of Skin

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Objective: To review the literature regarding the efficacy and safety of off-label use of apremilast in combination therapies for psoriasis and psoriatic arthritis and for other currently off-label inflammatory dermatoses. Methods: The Medline database was queried for all relevant articles published between 2014 and 2021 using exploded MeSH terms and keywords pertaining to the following themes: off-label, combination therapy, biologics, biologic therapy, methotrexate, and systemic psoriasis therapy. The Boolean term “AND” was used to find the intersection of these themes with the term “apremilast.” Results: 8 case series and 6 case reports investigated the use of apremilast in combination therapy for psoriasis and psoriatic arthritis. Addition of apremilast improved PASI scores by 31.8-77.4% among case series and 80-100% among case reports with adverse effects primarily consisting of gastrointestinal symptoms. 5 randomized-control trials (RCT), 9 open-label trials, 18 case series, and 30 case reports investigated the use of apremilast for off-label dermatoses. In RCTs, apremilast showed potential efficacy for atopic dermatitis and hidradenitis suppurativa. Open-label trials found apremilast efficacious for atopic dermatitis, allergic contact dermatitis, chronic pruritus, cutaneous sarcoidosis, discoid lupus erythematosus, hidradenitis suppurativa, lichen planus, prurigo nodularis, rosacea, and vitiligo. Limitations: Small sample size and short follow duration up for available randomized-control and open-label trials. Current data from case series/reports potentially limits generalizability of findings. Conclusion: Apremilast's safety profile makes it a potential efficacious, non-biologic systemic agent for monotherapy and combination therapy for a wide range of inflammatory dermatoses.

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Dual‐targeted therapy with apremilast and vedolizumab in pyoderma gangrenosum associated with Crohn’s disease

Cited by 10 publications

References 5 publications

Multiple Lesions at Different Stages of Pyoderma Gangrenosum in a Crohn’s Disease Patient

Multiple Lesions at Different Stages of Pyoderma Gangrenosum in a Crohn’s Disease Patient

Rapidly Progressing Aseptic Abscesses in a Patient with Ulcerative Colitis

Apremilast as an Off-Label Therapeutic Agent

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