P469 Self-reported cutaneous side effects of anti-TNF therapy in inflammatory bowel disease patients

Abstract

Background: Anti-TNF monoclonal antibodies are established induction and maintenance agents for inflammatory bowel disease (IBD). They are generally well tolerated with an extensively characterised side effect profile. While cutaneous side effects of these agents are known to occur, they are less well-described and few studies have evaluated patient-reported skin side effects. Our aim was to assess the prevalence and characteristics of self-reported cutaneous side effects in an IBD cohort receiving anti-TNF therapy. Methods: A prospective multi-centre study was conducted at two Irish Academic Medical Centres. Consecutive IBD patients with a history of anti-TNF therapy exposure were invited to complete a self-assessment questionnaire which focused on cutaneous symptoms. Clinical data were recorded including basic demographics, pre-existing skin conditions and development of cutaneous symptoms post anti-TNF therapy commencement. Results: A total of 78 patients completed the study questionnaire (mean age 41 years [range 18-72]; 54% male; 72% Crohn's disease (CD), 21% ulcerative colitis (UC) and 8% IBD-U. Mean anti-TNF therapy duration at time of questionnaire completion was 39 months [range 2-180]. 59% of subjects reported experiencing “skin changes” following the commencement of anti-TNF therapy with the reported time to development of symptoms (mean [range]) being 12 months [0-72]. The most common cutaneous symptoms experienced were “dry skin” (41%), “itch” (35%), and “redness” (26%). Of the 46% of subjects with a pre-existing dermatological condition, 31% described worsening of the condition after therapy commencement. Of those with pre-existing psoriasis, 13% reported it worsened during therapy. Only 26% of the study cohort reported seeking medical attention for cutaneous side effects. Therapy was prescribed in a minority of patients with emollient and topical steroids use reported in 31% and 17% of study subjects, respectively. Discontinuation of anti-TNF therapy was rarely required with n = 1 individual reporting anti-TNF therapy discontinuation due to cutaneous side effects. Conclusions: Cutaneous side effects of anti-TNF therapy are common and may be under-appreciated by practising clinicians and patients. Specific questioning regarding cutaneous side effects should be undertaken when reviewing IBD patients receiving anti-TNF therapy. While common, cutaneous side effects can be successfully managed using topical therapies and uncommonly lead to a requirement for therapy discontinuation.