Crohns Colitis. 2020 Apr 22;jjaa078 doi: 10.1093/ecco-jcc/jjaa078. Online ahead of print.

F M Phillips ¹, B Verstockt ^2 3, S Sebastian ^4 5, D G Ribaldone ⁶, S Vavricka ⁷, K Katsanos ⁸, E Slattery ⁹, N de Suray ^10 11, C Flores ¹², W Fries ¹³, F Vincenzi ¹⁴, E Capoferro ^14 15, O Bachmann ¹⁶, U Kopylov ¹⁷, ECCO CONFER investigators

Author information

¹NIHR Nottingham Digestive Diseases Biomedical Research Centre, Nottingham University Hospitals, Nottingham, UK.

²University Hospitals Leuven, Gastroenterology and Hepatology, Leuven, Belgium.

³KU Leuven, Chronic Diseases, Metabolism and Ageing, TARGID-IBD unit, Leuven, Belgium.

⁴Hull and East Yorkshire Hospitals NHS Trust, Inflammatory Bowel Disease Unit, Hull, UK.

⁵University of Hull and York, Hull York Medical School, Hull, UK.

⁶University of Turin, Surgical Sciences, Turin, Italy.

⁷University Hospital Zurich, Medicine, Zurich, Switzerland.

⁸University of Ioannina School of Medical Sciences, Gastroenterology, Ioannina, Greece.

⁹University Hospital Galway, Gastroenterology, Galway, Ireland.

¹⁰Grand Hopital de Charleroi, Gastroenterology and Hepatology, Charleroi, Belgium.

¹¹University Hospital Saint-Luc, Gastroenterology and Hepatology, Bruxelles, Belgium.

¹²Hospital de Clinicas de Porto Alegre, Gastroenterology, Rio Grande do Sul, Brazil.

¹³University Messina, Clinical Unit for Chronic Bowel Disorders, Messina, Italy.

¹⁴University of Parma, Gastroenterology and Endoscopy Unit, Parma, Italy.

¹⁵Sacro Cuore Don Calabria of Negrar, Negrar, Italy.

¹⁶Siloah St. Trudpert Klinikum, Pforzheim, Germany.

¹⁷Sheba Medical Centre, Gastroenterology, Ramat Gan, Israel.

Abstract

This was a multicentre case series supported by the European Crohn's and Colitis Organisation (ECCO) and, performed as part of the Collaborative Network of Exceptionally Rare case reports (CONFER) project. The aim was to report on whether cutaneous lesions associated with inflammatory bowel disease (IBD) and refractory to standard medical therapy including anti-TNFs, would respond to the newer biologic agents Ustekinumab (UST) or Vedolizumab (VDZ). This report includes 28 patients with cutaneous lesions form 14 centres, all of whom had failed immunomodulator and anti-TNF therapy. Metastatic Crohn's disease (MCD) was diagnosed in 10 patients: UST led to remission in 5 cases and partial response in 4 cases, with a single report of VDZ inducing remission. All cases of MCD treated with UST responded after the first or second dose, whilst the median time for the 5 cases that attained remission was 5 months. Pyoderma gangrenosum (PG) was diagnosed in 4 cases: 3 of these attained remission with UST (median time to remission 4 months) whilst one case did not respond to VDZ. There were 7 cases of erythema nodosum (EN): UST led to remission in 4 cases and partial response in 1 case whilst VDZ had partial response in 2 cases and non-response in 2 cases. There were 7 single cases of other inflammatory lesions. In summary, UST appears to be useful for different cutaneous lesions including MCD, PG and EN, whilst VDZ does not appear to be useful for lesions that are independent of disease activity.