TOPLINE:

In a retrospective review, the combination of tumor necrosis factor-alpha (TNF‑alpha) inhibitors with immunomodulators was associated with an increased risk for skin and soft tissue infections in pediatric patients with inflammatory bowel disease (IBD), particularly among those with Crohn’s disease (CD).

METHODOLOGY:

• Researchers conducted a retrospective review to determine the incidence of skin and soft tissue infections among 264 pediatric patients with IBD who received anti TNF-alpha therapy at a single center between January 2012 and June 2022.
• Overall, the analysis included 209 children with CD, 52 with ulcerative colitis, and 3 with unclassified IBD.
• Investigators evaluated two different TNF-alpha inhibitors, ie, adalimumab (n = 119) and infliximab (n = 145), and compared outcomes between those receiving a TNF-alpha inhibitor alone (n = 249) and those receiving combination therapy with immunomodulatory agents (n = 15).

TAKEAWAY:

• All patients receiving combination therapy (15/15) developed a skin and soft tissue infection compared with 15.3% (38/249) of those on TNF-alpha inhibitor monotherapy (P = .024).
• Skin and soft tissue infections were more common among those with CD (23%) than among those with ulcerative colitis (7.7%), with a significantly higher odds ratio (OR, 3.60; P = .019).
• The type of TNF-alpha inhibitor (adalimumab vs infliximab) did not significantly affect infection rates (P = .81).
• The development of skin and soft tissue infections did not significantly impact overall IBD management.

IN PRACTICE:

“Pediatric patients with CD, particularly those receiving combination therapy, are at greatest risk for skin and soft tissue infections while on anti-TNF-alpha therapy,” which “rarely lead to treatment interruption,” the authors wrote. These results “contribute to the growing literature on biologic safety in pediatric IBD and may inform clinician counseling and risk stratification,” they added, noting that “awareness of these patterns is essential to guide timely recognition, collaborative care, and appropriate treatment decisions” by dermatologists.

SOURCE:

The study was co-led by Jordan Kahle, MD, and Hailey Seibert, Case Western Reserve University School of Medicine, Cleveland, and was published online on as a brief report on January 28 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The study was limited by its retrospective, single-center design, and unequal representation between patients with ulcerative colitis and those with CD, which may have affected the generalizability of the findings.

DISCLOSURES:

The study was supported by the Clinical and Translational Science Collaborative of Northern Ohio through a National Institutes of Health, National Center for Advancing Translational Sciences Clinical and Translational Science Award grant. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.