IDDF2024-ABS-0047 Is ustekinumab useful for crohn’s disease patients with skin lesions developing after tumor necrosis factor-alpha inhibitors?

<h3>Background</h3> Ustekinumab (UST) is becoming widely used as a therapeutic option for Crohn’s disease (CD) as a biologic agent with a novel mechanism of interleukin (IL)-12/23 inhibition, which is expected to have therapeutic effects on pathology involving factors other than tumor necrosis factor (TNF). In this study, we investigated the therapeutic effect of UST on CD patients with paradoxical skin reactions to TNF inhibitors (TNFi) and long-term efficacy. <h3>Methods</h3> Fifty-four patients with CD who were introduced to UST as 2nd or 3rd Bio at our hospital from June 2017 to September 2020 were retrospectively enrolled in the study. TNFi-associated skin lesions were defined as skin lesions developing or worsening during TNFi treatment. Treatment discontinuation was defined as hospitalization, surgery, or treatment change due to CD exacerbation. <h3>Results</h3> Of the 54 patients, 10 had skin lesions associated with the previous TNFi treatment. Eight patients were males, and 2 were females. The median (interquartile range) values for each were: age, 35.4 (32.9–39.2) year-old; disease duration, 13.4 (6.4–18.1) years; Harvey-Bradshaw Index (HBI), 3 (1–5.5); CRP, 0.22 (0.04–0.38) mg/dL, Alb 3.95 (3.6–4.4) g/dL. Infliximab in 4 patients and adalimumab in 6 patients were used as the last TNFi. Of the 10 patients in the group with the skin lesions, 4 (50%; 2 psoriasiform eruptions, 2 folliculitis, and 1 palmoplantar pustulosis) achieved complete response, 5 (50%; 2 psoriasiform eruptions and 2 exacerbations of atopic dermatitis) achieved partial response of skin lesions. After 1 year of UST induction, the cumulative continuous treatment rate was 56.3% in the group with no skin lesions and 70% in the group with skin lesions, and there was no statistical difference between the two groups (Log-rank; P = 0.349) (IDDF2024-ABS-0047 Figure 1. The cumulative continuous Ustekinumab treatment rate). <h3>Conclusions</h3> UST was highly effective in treating TNFi-associated skin lesions (90% partial or complete response). The cumulative continuous treatment rate after induction of UST was comparable to that of the group without skin lesions, indicating that UST is useful for treating CD with TNFi-associated skin lesions.