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P578 Therapeutic strategies in the approach of paradoxical psoriasis in IBD: experience of a centre

S. Santos*1, V. Gamelas2, D. Carvalho2, C. Bernardes2, J. Saiote2, J. Ramos2

1Centro Hospitalar Lisboa Central EPE, Gastroenterology, Lisboa, Portugal, 2Centro Hospitalar Lisboa Central, Lisboa, Portugal

Background

Induction of psoriasis with the use of TNFα antagonists, also used in its treatment, is a phenomenon described in inflammatory bowel disease. We intended to analyse predictive factors for the development of this entity and results of the different strategies in its treatment.

Methods

Analysis of a cohort under treatment with anti-TNFα between 2005 and 2018. Patients who developed paradoxical psoriasis following onset of anti-TNFα, confirmed by Dermatology were compared with the group without occurrence of cutaneous lesions with treatment. Statistical analysis was performed using SPSS.

Results

291 patients were treated with anti-TNFα, of which 18 (6.2%) developed paradoxical psoriasis. Of these, 13 (72%) were female, with a mean age of 36 years. The majority were under infliximab (n = 14, 78%) and had Crohn's disease (n = 16, 88%). Extra-intestinal manifestations were present in 9 patients (50%) and the mean time until the development of paradoxical psoriasis was 2.8 years (1 month-10 years). Only 3 patients (16.6%) had active disease and 9 (50%) had perianal disease. From the studied variables, female gender and history of extra-intestinal manifestations were associated with the development of psoriatic lesions (p < 0.05). Topical and/or systemic therapy was used, with anti-TNFα being initially maintained, in 14 patients, with improvement of cutaneous lesions in 10 (partial improvement in 6). Anti-TNFα discontinuation was necessary in 7 patients: 2 due to recurrence of psoriasis after reintroduction of anti-TNFα; 2 for recurrence after switch and 3 for absence of skin lesions resolution despite systemic therapy. Swap to ustekinumab was made in 7 patients: complete resolution of the lesions was observed in 6 patients and partial improvement in 1 patient partial, whom maintaining adjuvant systemic therapy. Intestinal remission was maintenance/attainment in all patients.

Conclusion

In this cohort the development of paradoxical psoriasis in inflammatory bowel disease under anti-TNFα was 6.2%, with a higher prevalence in females and in the presence of extraintestinal manifestations. Definitive anti-TNFα suspension was required in 7 patients (38.8%) and the swap strategy was effective in most cases.