title: Concomitant use of azathioprine/6-mercaptopurine decreases the risk of anti-TNF-induced skin lesions.
abstract: BACKGROUND
  Anti-tumor necrosis factor (anti-TNF) agents are widely used to treat patients with moderate-to-severe inflammatory bowel disease (IBD). We aimed to identify the risk factors for adverse skin lesions in patients with IBD receiving anti-TNF agents and assess the effect of concomitant use of azathioprine/6-mercaptopurine (AZA/6 MP).
  
  
  METHODS
  A total of 500 patients (404 with Crohn's disease, 96 with ulcerative colitis) who received anti-TNF agents between June 2002 and July 2013 were identified and retrospectively investigated. We compared 47 patients with IBD with skin lesions with 443 patients with IBD without skin lesions to identify risk factors by univariate and multivariate analysis. The Kaplan-Meier method was used to estimate the cumulative incidence of adverse skin lesions in relation to the concomitant use of AZA/6 MP.
  
  
  RESULTS
  Eczematiform eruptions (n = 18, 38%) were the most common skin lesion type, followed by psoriasiform lesions (n = 13, 28%). A response to topical steroids was seen in 70% (33/47) of patients with skin lesions, and anti-TNF agents had to be discontinued in 9% (4/47). Concomitant use of AZA/6 MP decreased the risk of skin lesions in univariate (hazard ratio, 0.452; 95% CI, 0.251-0.814; P = 0.008) and multivariate (hazard ratio, 0.437; 95% CI, 0.242-0.790; P = 0.006) analysis. In addition, the cumulative incidence of adverse skin lesions was lower in patients on concomitant maintenance with AZA/6 MP (P = 0.009) than in those on anti-TNF monotherapy.
  
  
  CONCLUSIONS
  Concomitant use of AZA/6 MP may decrease the occurrence of adverse skin lesions in patients receiving anti-TNF therapy.
authors: Departments of *Gastroenterology, and †Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Jae Seung
authors: JS
authors: Soh
authors: Woo Jin
authors: WJ
authors: Yun
authors: Kyung-Jo
authors: KJ
authors: Kim
authors: Chong Hyun
authors: CH
authors: Won
authors: Sang Hyoung
authors: SH
authors: Park
authors: Dong-Hoon
authors: DH
authors: Yang
authors: Byong Duk
authors: BD
authors: Ye
authors: Jeong-Sik
authors: JS
authors: Byeon
authors: Seung-Jae
authors: SJ
authors: Myung
authors: Suk-Kyun
authors: SK
authors: Yang
authors: Jin-Ho
authors: JH
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000008:administration & dosage* / Q000009:adverse effects; D015992:Body Mass Index; D003093:Colitis, Ulcerative / Q000188:drug therapy; D003424:Crohn Disease / Q000188:drug therapy; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D011565:Psoriasis / Q000139:chemically induced / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking; D018417:Th1 Cells / Q000276:immunology; D058504:Th17 Cells / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D015122:Mercaptopurine; D001379:Azathioprine