P2561 - Risankizumab Sustains Remission and Improves Anti-TNF-Induced Psoriasiform Dermatitis in Well Controlled Crohn's Disease Patients Switched from Anti-TNF Therapy

Matthew Smyth, MD¹, Elizabeth Spencer, MD², Hyder Said, MD², Ryan C. Ungaro, MD², Marla C. Dubinsky, MD^2
1Icahn School of Medicine at Mount Sinai, Vancouver, BC, Canada; ²Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Paradoxical anti-TNF-induced psoriasiform dermatitis (PD) continues to limit treatment durability, with eczema history increasing risk of PD. Switching to anti-IL-12/23 is effective in some, with emerging evidence for use of anti-IL-4 targets. The efficacy of risankizumab (RZB) for anti-TNF-induced PD in Crohn’s Disease remains unknown.

Methods: A single center retrospective chart review identified CD patients with anti-TNF-induced PD switched from TNF to RZB between June 2022 and November 2023. Patients not in steroid free clinical remission (SFCR) at the time of switch or with < 12 weeks of RZB at last follow-up were excluded. TNF-induced-PD was scored as resolved, mild or severe. The primary outcome was sustained SFCR and PD resolution on RZB at last follow-up. Secondary outcomes included frequency of PD improvement and PD resolution. Descriptive statistics summarized the data (Median [IQR] or frequencies) and univariate tested associations.

Results: Twenty-one patients with TNF-induced-PD switched from anti-TNF (Infliximab 71%, adalimumab 24%, golimumab 5%) to RZB; 13(62%) female; Median [IQR] age: 33 [21-38] years, disease duration 9 [6-17] years, time from anti-TNF initiation to development of PD 46.9 [23.2-83.7] months, time from developing PD to starting RZB 11.5 [4.5-50.7] months (table). Seventeen (81%) PD reactions were classified as severe. Scalp, ears, and trunk were most frequently affected areas (38%, 33%, 33% respectively), with 81% of patients having >1 affected region. Six (29%) had either a personal and or family history of eczema. All patients were on topical therapy and 1 was on oral antibiotics for their PD at RZB switch. At last follow-up (257 [160-365] days on RZB), all 20 patients remaining on RZB sustained SFCR and had complete resolution (N=11,55%) or improvement in PD (n=9, 45%). Patients not achieving PD resolution had numerically shorter exposure to RZB at follow-up (173 vs 314 days), severe skin reaction at baseline (50% vs 25% mild) and higher reported eczema history (67% vs 36%). One patient stopped RZB secondary to joint pain, returning to anti-TNF with recurrence of their PD, and subsequently switched to upadacitinib with resolution.

Discussion: In patients with anti-TNF-induced PD, RZB significantly improves PD and maintains disease control. Eczema is an important risk factor for developing PD and may impact PD outcomes. IL-4 targeted therapies may be a more biology driven approach to anti-TNF induced PD.


Disclosures:


Matthew Smyth, MD¹, Elizabeth Spencer, MD², Hyder Said, MD², Ryan C. Ungaro, MD², Marla C. Dubinsky, MD². P2561 - Risankizumab Sustains Remission and Improves Anti-TNF-Induced Psoriasiform Dermatitis in Well Controlled Crohn's Disease Patients Switched from Anti-TNF Therapy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.