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Summaries for Patients |5 January 2016

Rashes in Patients With Ulcerative Colitis or Crohn Disease Being Treated With Drugs That Block Tumor Necrosis Factor Free

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This article was published online first at www.annals.org on 8 December 2015.
  • The full report is titled “Characteristics of Skin Lesions Associated With Anti–Tumor Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease: A Cohort Study.” It is in the 5 January 2016 issue of Annals of Internal Medicine (volume 164, pages 10-22). The authors are I. Cleynen, W. Van Moerkercke, T. Billiet, P. Vandecandelaere, N. Vande Casteele, C. Breynaert, V. Ballet, M. Ferrante, M. Noman, G. Van Assche, P. Rutgeerts, J.J. van den Oord, A. Gils, S. Segaert, and S. Vermeire.


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    • What is the problem and what is known about it so far?
    • Why did the researchers do this particular study?
    • Who was studied?
    • How was the study done?
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What is the problem and what is known about it so far?

Patients with inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn disease, experience belly problems, such as severe pain, blockages of the intestines, or bleeding. In some patients, the disease is severe enough to require treatment with drugs that block the function of tumor necrosis factor (TNF), a protein involved in inflammation. Although TNF-blocking drugs are effective for IBD symptoms in many patients, some patients develop troubling skin problems that cause them to stop the TNF-blocking drug. These skin problems have included psoriasis and eczema. How often skin problems develop in these patients and whether they can be treated without stopping the TNF-blocking drug is not known.

Why did the researchers do this particular study?

To find out how often skin problems develop in these patients and whether they can be treated without stopping the TNF-blocking drugs.

Who was studied?

917 patients with IBD starting therapy with a TNF-blocking drug.

How was the study done?

The physicians followed the patients closely and regularly asked them about skin problems. Patients with skin problems were referred to a dermatologist with experience in this area. The researchers reviewed the charts of these patients to see how often skin problems occurred, whether they were successfully treated, and whether the TNF-blocking drugs were stopped. They also did blood testing on some of the patients to determine which genes were found in patients who did or did not develop skin problems.

What did the researchers find?

About one third of the patients developed skin problems while being treated with a TNF-blocking drug. The time between starting the TNF-blocking drug and the appearance of the skin problem varied from less than half a year to more than 4 years. Nearly 20% of the patients with skin lesions did not require any specific treatment for them; of those who did, about half needed only skin creams. A small number needed to take pills to control the skin lesions. Most patients had a good response to treatment of their skin problem. About 10% of the patients who developed skin problems, however, stopped the TNF-blocking treatment because of this issue. The researchers found that some genes seemed to be present more commonly in patients who developed skin problems, and further study is planned to see whether this information might be helpful in understanding and treating the problem.

What were the limitations of the study?

The kind of skin problems that were studied may occur with IBD itself, even without the use of TNF-blocking drugs. Although skin lesions were seen in association with TNF-blocking drugs, this kind of study cannot establish whether the lesions were caused by the drugs, the patients' disease, or both.

What are the implications of the study?

Patients with IBD who are treated with TNF-blocking drugs should tell their physician if they develop skin problems. Evaluation and treatment for these skin problems may be effective for many patients, and most patients seem to be able to continue with the TNF-blocking treatment.

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Rashes in Patients With Ulcerative Colitis or Crohn Disease Being Treated With Drugs That Block Tumor Necrosis Factor. Ann Intern Med. 2016;164:I–11. doi: 10.7326/P16-9000

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Published: Ann Intern Med. 2016;164(1):I-11.

DOI: 10.7326/P16-9000

Published at www.annals.org on 8 December 2015

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Characteristics of Skin Lesions Associated With Anti–Tumor Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease: A Cohort Study
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