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P562. Anti-TNF alpha blocking agents as a first-line therapy for IBD-associated pyoderma gangrenosum

M. Fortuna, R. Montanari, A. Geccherle, M. Chiaramonte, Sacro Cuore Don Calabria Negrar Hospital, Multispecialistic Centre for Recto-Perineal Diseases (IBD Unit), Department of Gastroenterology, Negrar (VR), Italy

Background

Pyoderma gangrenosum (PG) is an immune-mediated ulcerating skin disease affecting 1 to 5% of patients (pts) with inflammatory bowel disease (IBD). Its treatment can be troublesome and there is currently no gold standard therapy (tp) for PG. Several reports describe the successful use of biological agents (Ba) in the treatment of IBD-associated refractory PG. However, data on their efficacy as a first-line tp are lacking.

The aim of this study is to evaluate PG healing using anti-tumor necrosis factor alpha (TNFa) blocking agents as a first-line tp.

Methods

Out of pts enrolled in the IBD Unit at Negrar Hospital (Vr-Italy) from Jan 2009 to Aug 2013, we recruited retrospectively the ones who developed PG.

Diagnosis of PG was based on dermatologic clinical evaluation.

We recorded the following data: age, sex, duration of IBD, disease activity, according to Truelove and Witt's criteria for ulcerative colitis (UC) and Harvey–Bradshaw Index (HBI) for Crohn's disease (CD), healing time of PG and adverse events to Ba.

Infliximab (IFX) (5 mg/kg iv. at weeks (w) 0, 2, 6 and every 8 w after that) was the Ba of choice. Adalimumab (ADA) (160 mg sc. at w 0, 80 mg at w 2 and then 40 mg every other w) was chosen as a second line tp in pts who had previously adverse reactions to IFX.

Results

Out of 506 pts, 5 (1%) developed PG (2 males and 3 females; age 29–57; 3 with UC and 2 with CD). In 2 pts skin lesions appeared at IBD diagnosis. 4/5 had moderate to severe bowel disease activity, one had clinically inactive CD. 4 pts were treated with IFX, one received ADA.

In all pts both the skin lesions and bowel symptoms regressed significantly after Ba induction tp. Complete healing of PG without recurrence was achieved within 10 to 17 w (mean time 12.8 w). No treatment-related adverse events were observed.

Conclusion

PG is a rare extraintestinal manifestation of IBD pts and appears predominantly during active disease. Anti-TNFa tp as a first-line agent for IBD-associated PG should be considered, as it appears to be safe and highly effective.