Please use this identifier to cite or link to this item:
Scopus Web of Science® Altmetric
Type: Journal article
Title: Systematic review: IBD-associated pyoderma gangrenosum in the biologic era, the response to therapy
Author: Andrews, J.
Citation: Alimentary Pharmacology & Therapeutics, 2013; 38(6):563-572
Publisher: Blackwell Publishing Ltd
Issue Date: 2013
ISSN: 0269-2813
Statement of
A. Agarwal & J. M. Andrews
Abstract: <h4>Background</h4>Pyoderma gangrenosum (PG) in inflammatory bowel disease (IBD) is uncommon and therapeutically challenging. Its treatment remains poorly characterised due to limited individual centre or practitioner experience. No large series are reported since 2003, yet IBD treatment has changed substantially.<h4>Aim</h4>To provide an up-to-date review of the published treatment efficacy of currently available therapies for IBD-related PG in the biologic era.<h4>Methods</h4>Systematic review of cases published post-2003 since the broad availability of anti-tumour necrosis factor-alpha (TNFα) therapy. Cases which did not have coexistent IBD, were non-English language, of paediatric age or without data on response to therapy were excluded.<h4>Results</h4>Sixty cases were identified; 55% female, 50% UC, 45% CD, 5% IBD-U. At PG diagnosis, 58% had active and only 15% inactive IBD, with 27% with IBD activity unspecified. Predominant sites were lower limb (48%) and peristomally (25%); 42% had multiple lesions. In 12%, trauma preceded PG. In 42%, new PG appeared whilst on IBD-specific therapy, whilst 28% were on no therapy and in 30%, IBD therapy was unspecified. Of patients on no therapy at PG onset (n = 17), 16 healed; seven with first- and eight with second-line therapy. In total, 34/60 patients received infliximab, four received adalimumab, two had both; with 33 (92%) responding to one or the other. There was no correlation of PG duration or size with healing times.<h4>Conclusions</h4>Pyoderma gangrenosum appears predominantly during active IBD and is seen equally in CD and UC. New PG may be a manifestation of recrudescent IBD or it follow trauma. Anti-TNFα therapy as a first-line agent for PG should be considered, as it appears to be highly effective.
Keywords: Humans; Inflammatory Bowel Diseases; Pyoderma Gangrenosum; Tumor Necrosis Factor-alpha; Dermatologic Agents; Antibodies, Monoclonal; Treatment Outcome; Antibodies, Monoclonal, Humanized; Adalimumab; Infliximab
Rights: © 2013 John Wiley & Sons Ltd
RMID: 0020131514
DOI: 10.1111/apt.12431
Appears in Collections:Medicine publications

Files in This Item:
There are no files associated with this item.

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.