title: Methotrexate for psoriasiform lesions associated with anti-tumour necrosis factor therapy in inflammatory bowel disease.
abstract: BACKGROUND
  Psoriasiform lesions associated with anti-tumour necrosis factor (TNF) therapy are frequent in patients with inflammatory bowel disease (IBD). While methotrexate is the most frequently used systemic treatment for psoriasis, its efficacy for psoriasiform lesions related to anti-TNF therapy remains unknown.
  
  
  OBJECTIVE
  To assess the efficacy of methotrexate for psoriasiform lesions associated with anti-TNF therapy refractory to topical therapy in IBD patients.
  
  
  METHODS
  The charts of eight patients from the Nancy IBD cohort who developed psoriasiform lesions on anti-TNF therapy were reviewed. Clinical response was defined as a decrease of more than 50% in the lesions covering surface. All patients were followed up by the same experienced dermatologist.
  
  
  RESULTS
  Eight women (seven Crohn's disease) were followed up for a median duration of 29 months (range, 20-45). Of the eight patients receiving methotrexate, three were primary responders without discontinuation of anti-TNF agents. Only one patient had a sustained response at final follow-up and was able to continue both methotrexate and anti-TNF therapy. Of the two other primary responders, one patient had to discontinue anti-TNF because of severe psoriasiform lesions, whereas the other one continued anti-TNF therapy despite persistent skin lesions at final follow-up. Among the five primary nonresponders, four patients had to stop anti-TNF treatment due to disabling skin lesions.
  
  
  CONCLUSIONS
  Methotrexate does not appear effective in treating psoriasiform lesions associated with anti-TNF therapy refractory to topical therapy in IBD.
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, France.
authors.forename: A
authors.initials: A
authors.lastname: Buisson
authors.forename: J-F
authors.initials: JF
authors.lastname: Cuny
authors.forename: A
authors.initials: A
authors.lastname: Barbaud
authors.forename: J-L
authors.initials: JL
authors.lastname: Schmutz
authors.forename: M-A
authors.initials: MA
authors.lastname: Bigard
authors.forename: J-L
authors.initials: JL
authors.lastname: Guéant
authors.forename: L
authors.initials: L
authors.lastname: Peyrin-Biroulet
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011565:Psoriasis / Q000139:chemically induced / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D008727:Methotrexate