Inflammatory Cutaneous Lesions Improve With Ustekinumab Treatment

By Reuters Staff

May 08, 2020

NEW YORK (Reuters Health) - Ustekinumab treatment is associated with improvements in inflammatory cutaneous lesions in patients with inflammatory bowel disease (IBD), according to a multicenter case series.

Inflammatory cutaneous lesions are common extraintestinal manifestations of IBD. They are often difficult to treat even with anti-TNF agents.

Dr. Frank M. Phillips of Nottingham University Hospitals, in the U.K., and colleagues in the European Crohn's and Colitis Organization and Collaborative Network of Exceptionally Rare (CONFER) case reports project evaluated the efficacy of ustekinumab (a monoclonal antibody that targets the common p40 subunit of IL-12 and IL-23 cytokines) and vedolizumab (a monoclonal antibody that targets alpha4beta7 integrin) for treating different types of anti-TNF-refractory cutaneous lesions in IBD.

The study included 28 patients (20 female; median age, 37 years) from 14 different centers. Most (23/28) had Crohn's disease, five had ulcerative colitis, 19 were treated with ustekinumab, and 11 were treated with vedolizumab (two patients were treated with both).

Seven patients had erythema nodosum, the most common cutaneous lesion in IBD. Two cases achieved remission with ustekinumab after nonresponse to vedolizumab, and ustekinumab brought remission in another two cases and a partial response in one case. Two further cases had partial responses with vedolizumab.

Four patients had pyoderma gangrenosum, the second-most common cutaneous lesion in IBD. Three of these cases achieved remission with ustekinumab, but the fourth case did not respond to vedolizumab.

Ten patients had metastatic Crohn's disease, one of the rarest cutaneous lesions in IBD. Ustekinumab therapy was associated with remission in five cases and partial responses in four cases. Two of these cases had not responded to vedolizumab, but vedolizumab led to remission in a single case.

There were seven single cases of other inflammatory lesions, the authors report in the Journal of Crohn's and Colitis. Among these cases were a case of leukocytoclastic vasculitis that achieved remission with vedolizumab, a case of hidradenitis suppurativa that responded partially to ustekinumab, and a case of dissecting cellulitis of the scalp that did not respond to ustekinumab.

"Ustekinumab appears to be useful for different cutaneous lesions, including metastatic Crohn's disease, pyoderma gangrenosum, and erythema nodosum, whilst vedolizumab does not appear to be useful for lesions that are independent of disease activity," the authors conclude.

The study had no funding. Several authors report ties to Janssen, which sells ustekinumab as Stelara.

Dr. Phillips and co-author Dr. Uri Kopylov did not respond to a request for comments.

SOURCE: Journal of Crohn's and Colitis, online April 22, 2020.