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P611. “An old and inexpensive drug to minimize the side effects of a new and expensive one”: Colchicine for the skin lesions induced by the tumor necrosis factor-alpha inhibitors, a case-series study

J.M. Mella1, R. Gonzalez1, B. Vizcaino1, G. Casas1, M. Larralde1, S.C. Pedreira1, L. Boerr1, 1Hospital Aleman, Buenos Aires, Argentina

Background

Anti-tumor necrosis factor (TNF) antibodies (infliximab and adalimumab) represent the major biological therapy for inflammatory bowel diseases (IBD). These drugs induced dermatologic side effects. Our aims were to report a case series of patients with anti-TNF inhibitors-induced skin lesions during therapy for IBD, and to emphasize the usefulness of an old-fashion and inexpensive drug, colchicine, to adequately control this phenomenon.

Methods

Patients with IBD treated with anti-TNF drugs, who consulted at our Gastrointestinal Unit from January 2010 to June 2012, who presented with skin lesions as side effects of the biological therapy were included. All patients were seen by a Dermatologist and skin biopsies were performed.

Results

In this period, 43 patients with IBD were treated with biological therapy (29 patients with infliximab and 14 with adalimumab), accounting an incidence of 6.9% for biological therapy-induced skin lesions. We report 3 patients with IBD and biological therapy-induced skin lesions who were treated with colchicine with an excellent response. The characteristic of the patients and the biological therapies received are described in Table 1. All the patients presented with psoriasis-like skin lesions. The histopathological examinations of the skin biopsies showed findings compatible with pharmacodermia in patient #1 and psoriasis-like in patients #2 and #3.

The doses of colchicine used were 1 mg/day. The skin lesions gradually disappeared and a complete resolution of the lesions was observed after 3–6 months of treatment. The mean follow-up was 14 months. No recurrences were observed.

Table 1
CharacteristicPatient #1Patient #2Patient #2
GenderFemaleFemaleFemale
Age (years)684042
IBD typeCrohn's diseaseCrohn's diseaseCrohn's disease
Biological therapy drug and duration (months)Adalimumab (2)Infliximab (1.5)Adalimumab (1)
Reason for receiving biological therapyCrohn's disease refractorySeronegative arthritisSeronegative arthritis, ankylosing spondylitis
Skin lesion typePsoriasis-like skin lesions (Erythema multiforme)Psoriasis-like skin lesionsPsoriasis-like skin lesions
Management of this side effectSuspension of biological therapy. Oral steroids (without improvement)Suspension of biological therapySuspension of biological therapy
Colchicine (dose and duration of treatment)1 mg/day for 4 months1 mg/day for 6 months1 mg/day for 3 months
Follow-up (months)181212

Conclusion

Colchicine is a safe, inexpensive and useful anti-inflammatory drug to minimize the skin lesions (side effects) induced by TNF alpha inhibitors.