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P375 Inflammatory cutaneous lesions in inflammatory bowel disease treated with vedolizumab or ustekinumab: an ECCO CONFER multi-centre case series

F. M. Phillips*1, B. Verstockt2,3, S. Sebastian4,5, D. G. Ribaldone6, S. Vavricka7, K. Konstantinos8, E. Slattery9, N. de Suray10,11, C. Flores12, W. Fries13, F. Vincenzi14, E. Capoferro15, O. Bachmann16, U. Kopylov17, ECCO CONFER Investigators1

1St Mark's Hospital, Inflammatory Bowel Disease, London, UK, 2University Hospitals Leuven, Gastroenterology and Hepatology, Leuven, Belgium, 3KU Leuven, Chronic Diseases, Metabolism and Ageing, Leuven, Belgium, 4Hull and East Yorkshire Hospitals NHS Trust, Inflammatory Bowel Disease Unit, Hull, UK, 5University of Hull and York, Hull York Medical School, Hull, UK, 6University of Turin, Surgical Sciences, Turin, Italy, 7University Hospital Zurich, Medicine, Zurich, Switzerland, 8University of Ioannina School of Medical Sciences, Gastroenterology, Ioannina, Greece, 9University Hospital Galway, Gastroenterology, Galway, Ireland, 10Grand Hopital de Charleroi, Gastroenterology and Hepatology, Charleroi, Belgium, 11University Hospital Saint-Luc, Gastroenterology and Hepatology, Bruxelles, Belgium, 12Hospital de Clinicas de Porto Alegre, Gastroenterology, Rio Grande do Sul, Brazil, 13University Messina, Clinical Unit for Chronic Bowel Disorders, Messina, Italy, 14University of Parma, Gastroenterology and Endoscopy Unit, Parma, Italy, 15Sacro Cuore Don Calabria of Negrar, Negrar, Italy, 16Hannover Medical School, Gastroenterology, Hepatology and Endocrinology, Hannover, Germany, 17Sheba Medical Centre, Gastroenterology, Ramat Gan, Israel

Background

Inflammatory cutaneous lesions are a common extraintestinal manifestation of inflammatory bowel disease (IBD). However, it is unknown whether such lesions, which may be refractory to standard medical therapy including anti-TNFs, would respond to the newer biologic agents ustekinumab (UST) or vedolizumab (VDZ).

Methods

This was a European Crohn’s and Colitis Organisation (ECCO) retrospective multi-centre case series, performed as part of the CONFER project. A call to all ECCO members was made to report on cutaneous lesions in IBD treated by UST or VDZ, excluding psoriasiform lesions. Clinical data were recorded in a standardised data collection form.

Results

This report includes 28 patients with cutaneous lesions form 14 centres; 23 had Crohn’s disease and 5 had ulcerative colitis whilst 19 were treated with UST and 11 with VDZ (2 patients were treated with both). All had failed immunomodulators and anti-TNF therapy. Metastatic Crohn’s disease (MCD) was diagnosed in 10 patients (9 confirmed by histology) and UST therapy led to remission in 5 cases and partial response in 4 cases, with a single report of VDZ inducing remission. All cases of MCD that were treated with UST responded after the first or second dose, whilst for the 5 cases that attained remission, the median time for this was 5 months. Pyoderma gangrenosum (PG) was diagnosed in 4 cases; 3 of these attained remission with UST (median time to remission 4 months) whilst one case did not respond to VDZ. There were 7 cases of erythema nodosum (EN); UST led to remission in 4 cases and partial response in 1 case whilst VDZ had partial response in 2 cases and non-response in 2 cases. There were 7 single cases of other inflammatory lesions, which included: a case of leukoclastic vasculitis that attained remission with VDZ, a case of hidradenitis suppurotiva (HS) with partial response to UST, a case of dissecting cellulitis of the scalp that did not respond to UST; 2 unspecified cases with partial response to VDZ and another two unspecified cases with no response to VDZ.

Conclusion

This is the first case series to describe the efficacy of UST and VDZ in the treatment of cutaneous lesions related to IBD. UST led to a remission or a partial response in all cases of MCD, PG, HS and EN. VDZ caused a partial response or non-response in EN and other inflammatory lesions, as well as a single case of remission in MCD.