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IBD-associated pyoderma gangrenosum in the biologic era

The latest issue of Alimentary Pharmacology & Therapeutics reviews the response to therapy for inflammatory bowel disease-associated pyoderma gangrenosum in the biologic era.

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Pyoderma gangrenosum in inflammatory bowel disease is uncommon and therapeutically challenging.

Its treatment remains poorly characterized due to limited individual center or practitioner experience.

No large series are reported since 2003, yet inflammatory bowel disease treatment has changed substantially.

Dr Agarwal and colleagues from Australia provided an up-to-date review of the published treatment efficacy of currently available therapies for inflammatory bowel disease-related pyoderma gangrenosum in the biologic era.

Systematic review of cases published post-2003 since the broad availability of anti-tumour necrosis factor-alpha therapy.

In 12%, trauma preceded pyoderma gangrenosum
Alimentary Pharmacology & Therapeutics

Cases which did not have coexistent inflammatory bowel disease, were non-English language, of paediatric age or without data on response to therapy were excluded.

The team identified 60 cases, of which 55% were female, 50% had ulcerative colitis, 45% had Crohn's disease, and 5% inflammatory bowel disease.

At pyoderma gangrenosum diagnosis, 58% had active, and only 15% inactive inflammatory bowel disease, with 27% with inflammatory bowel disease activity unspecified.

The research team found that predominant sites were lower limb and peristomally, and 42% had multiple lesions.

In 12%, trauma preceded pyoderma gangrenosum.

The researchers found that in 42%, new pyoderma gangrenosum appeared whilst on inflammatory bowel disease-specific therapy, whilst 28% were on no therapy and in 30%, inflammatory bowel disease therapy was unspecified.

Of patients on no therapy at pyoderma gangrenosum onset, the team found that 16 healed, of which 7 had first- and eight with second-line therapy.

In total, 34 out of 60 patients received infliximab, 4 received adalimumab, 2 had both, with 33 responding to one or the other.

The team observed no correlation of pyoderma gangrenosum duration or size with healing times.

Dr Agarwal's team concludes, "Pyoderma gangrenosum appears predominantly during active inflammatory bowel disease and is seen equally in Crohn's disease and ulcerative colitis."

"New pyoderma gangrenosum may be a manifestation of recrudescent inflammatory bowel disease or it follow trauma."

"Anti-TNFa therapy as a first-line agent for pyoderma gangrenosum should be considered, as it appears to be highly effective."

Aliment Pharmacol & Ther 2013: 38(6): 563572
11 September 2013

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