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Infliximab paradoxical psoriasis in a cohort of children with inflammatory bowel disease

Courbette, Olivier*; Aupiais, Camille*,†; Viala, Jerome*; Hugot, Jean-Pierre*,‡; Louveau, Baptiste*; Chatenoud, Lucienne§; Bourrat, Emmanuelle*,||; Martinez-Vinson, Christine*

Journal of Pediatric Gastroenterology and Nutrition: March 26, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002349
Original Article: Gastroenterology: PDF Only
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Objectives: In adult inflammatory bowel disease (IBD) treated by anti-TNF antibodies, paradoxical psoriasis has an estimated prevalence of 1.6 to 22%, especially in infliximab (IFX)-treated patients. Little is known in the pediatric IBD (PIBD) populations.

Methods: All patients aged from 2 to 18 years with Crohn's disease (CD) or Ulcerative colitis (UC) and treated for the first time by IFX between January 2002 and March 2014, were considered for inclusion in this retrospective study performed in a tertiary PIBD centre. Paradoxical psoriasis events together with clinical and biological data were collected in all patients. Comparisons between psoriasis and control groups were performed using univariate statistical analyses.

Results: 123 CD patients and 24 UC patients were treated with IFX. 20 patients (13.6%) experienced a paradoxical psoriasis. All of them were affected by CD. Perianal CD was more frequent in the psoriasis group (p = 0.033). 14 patients (70%) were in remission when skin lesions occurred. Paradoxical psoriasis was diagnosed 355 days (median, IQR: 239; 532) after the initiation of IFX corresponding to the 8th injection (median, IQR: 6; 15). Psoriasis lesions were controlled by local steroids in all cases and no patients discontinued IFX therapy.

Conclusion: 13.6% of our IBD patients treated with IFX developed psoriasis during a median follow-up of 23.9 months (IQR: 11.6; 36.5). CD patients with perianal disease were at a higher risk to develop this common side effect.

*Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris France

Université Paris Diderot, INSERM UMR 1123 (ECEVE), Paris France

Université Paris Diderot INSERM UMR 1149, Paris France

§Université Paris Descartes, Sorbonne Paris Cité, Paris, France, INSERM U1151, CNRS UMR 8253, Hôpital Necker-Enfants Malades, Paris, France

||Assistance publique-Hôpitaux de Paris, Hôpital Saint Louis, France.

Address correspondence and reprint requests to Christine Martinez-Vinson, Service des maladies digestives et respiratoires de l’enfant, Hôpital Robert Debré. 48 Boulevard Sérurier, 75019 Paris (e-mail: christine.martinez-vinson@aphp.fr).

Received 14 February, 2019

Accepted 14 March, 2019

Conflicts of interest: CMV received honoraria, speaker's fees and/or congress fees from AbbVie, MSD, Nestle, Biogen. JPH received congress fees from MSD, Biogen.

Supported by: No funding was received for the study.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,