Ustekinumab for skin reactions associated with anti‐tumor necrosis factor‐α agents in patients with inflammatory bowel diseases: A single‐center retrospective study

Abstract

Anti‐tumor necrosis factor (TNF)‐α agents may induce skin reactions, in particular in patients with inflammatory bowel diseases (IBD). The objective of this study was to determine the efficacy of ustekinumab in these patients. IBD patients facing therapeutic issues because of cutaneous reactions or tolerance issues, consequently treated with ustekinumab in our department, were included. Retrospective review of case records and clinical photographs was carried out. Twenty‐six patients were included. Twenty‐three patients were treated for Crohn's disease and three for ulcerative colitis. Fourteen patients presented psoriasiform lesions, nine eczematiform lesions, four anaphylactoid reactions, two alopecia areata‐like lesions, one injection‐site reaction, one cutaneous polyarteritis nodosa and five other skin reactions. Most of them resolved under ustekinumab. In detail, eczematiform lesions completely resolved in all cases, psoriasiform lesions completely resolved in 12 cases (85.7%) and had partial response in two cases (14.3%). Two cases of alopecia areata showed complete response (complete hair regrowth). Fourteen patients showed complete digestive response, 10 patients partial digestive response (seven of which needed IBD treatment optimization) and only two failure. In conclusion, ustekinumab is a drug of choice in patients with IBD who cannot tolerate TNF blockers.

Clinical approach to skin eruptions induced by anti-TNF agents among patients with inflammatory bowel diseases: insights from a multidisciplinary IBD-DERMA clinic

“… 21 However, its effectiveness for paradoxical skin eruption induced by anti-TNF data is still scarce. 22 , 23 …”

“…21 However, its effectiveness for paradoxical skin eruption induced by anti-TNF data is still scarce. 22,23 In paradoxical psoriasis, TNF inhibition precludes dendritic cell maturation, thus leading to sustained interferon (IFN) α induced acute inflammation in genetically predisposed individuals. 24 As paradoxical psoriasis is IFN α driven, withdrawal of anti-TNF leads to the resolution of skin eruption in a significant proportion of patients.…”

Rapid Induction and Maintenance of Remission in Refractory Ulcerative Colitis with Ustekinumab

“…Ustekinumab was reported to completely resolve psoriasic form lesions in 12 (85.7%) patients, two (14.3%) demonstrated partial response, 14 (61%) had complete digestive response, 10 (44%) had partial digestive response, and two (9%) failed to positively respond. Therefore, ustekinumab is recommend as a drug of choice in these patients [14]. While this paper was under review (September 4, 2019), the European Commission has recently approved the expanded use of ustekinumab (Stelara ® ) by Janssen's, for the treatment of moderately to severely active ulcerative colitis in the European Union [15].…”

The Association between Alopecia and Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

“…There are reports of 134 patients who developed alopecia as a side effect of IBD therapy (Table 4). Of those, 78 (58.2%) were on anti-TNF-α therapy (infliximab, adalimumab, certolizumab); 50 (37.3%) on thiopurine (azathioprine; 6-thioguanine), 4 (2.98%) on methotrexate, 1 (0.74%) on mesalamine, and 1 (0.74%) on sulfasalazine [3, 10, 13-16, 18-20, 25, 26, 29, 36, 37, 39-42, 44, 45, 50, 57, 60, 62, 64, 69-78, 80, 84-86, 88].…”

“…In these studies, the authors did not specify the period from the onset of alopecia to hair growth. Fifteen patients experienced regrowth of hair after switching to a biologic ( n = 9, ustekinumab; n = 1, certolizumab; n = 3, adalimumab); 11 (85.7%) of these were previously on infliximab [3, 10, 18, 20, 25, 41, 42, 71, 77].…”