P0885 Therapeutic Concepts for Pyoderma Gangrenosum as an Extraintestinal Manifestation in Chronic Inflammatory Bowel Diseases
J Guse, J Rüddel, N Teich, A Stallmach, K LangeAbstract
Background
Extraintestinal manifestations (EIM) are common complications of inflammatory bowel disease (IBD), occurring in 6–48% of patients. Among these, pyoderma gangrenosum (PG) is relatively rare but challenging to treat due to its potentially aggressive course. This condition poses a significant therapeutic challenge. This retrospective analysis aims to characterize affected patients and evaluate the efficacy of various therapeutic approaches on both IBD activity and PG healing, with the goal of identifying optimal treatment strategies, particularly for patients with multiple prior therapies.
Methods
In a retrospective multicenter study, patients with IBD and PG were analyzed. Demographic data, prior medications, surgeries, and disease-specific factors were considered to assess different treatment strategies.
Results
The cohort included 22 patients (median age: 47 years; 73% were women). Crohn’s disease was present in 77% of cases, while 23% had ulcerative colitis. More than half of the patients (59%) had undergone surgery, 85% of whom had an intestinal stoma. 50% of patients had received prior biologic therapy, with 82% treated using anti-TNF agents. PG most commonly affected the lower extremities (55%) or peristomal areas (41%). 17 patients received anti-TNF therapy (mostly infliximab as first- or second-line treatment), which resulted in complete healing in 88% of cases. Systemic steroid therapy (prednisolone) was used in 11 patients (50%), leading to partial improvement in less than 20%. Tacrolimus was administered to 8 patients, with a response rate of 63% and complete healing in 50%. One non-responder to tacrolimus successfully switched to infliximab. All patients responded to at least one anti-TNF agent, while tacrolimus failed as a first-line therapy in 75% of cases. One patient received a JAK inhibitor but did not achieve PG healing. Among those with complete PG healing, 15 patients (79%) were also in clinical remission. The median time to achieve complete healing of PG was five months. Complete healing of PG was achieved in 19 patients (86%).
Conclusion
These findings demonstrate that anti-TNF therapy is an effective treatment strategy for patients with IBD and pyoderma gangrenosum, proving successful as a first- or second-line treatment. Switching between anti-TNF agents was beneficial in cases of initial treatment failure. Systemic steroids showed limited success and Tacrolimus showed some efficacy. Both were inferior to anti-TNF therapy, especially as a first-line option. Complete healing of PG correlates with clinical remission of IBD and may take several months, a consideration important for treatment selection and evaluation. In summary, anti-TNF agents should be the primary therapeutic option for PG in IBD patients.