Letter: anti-TNFs and psoriasis
– friends
or foes? Authors
’ reply
A. Buisson*,†,‡& L. Peyrin-Biroulet‡
*Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d’Auvergne, Clermont-Ferrand, France.
†Microbes, intestine, inflammation and susceptibility of the host,
UMR Inserm/Université d’Auvergne U1071, USC-INRA 2018, Clermont Université, Clermont-Ferrand, France.
‡Inserm U954 and Department of Hepato-Gastroenterology,
University Hospital of Nancy, Université HenriPoincaré 1, Vandoeuvre-lès-Nancy, France.
E-mail: peyrinbiroulet@gmail.com doi:10.1111/j.1365-2036.2012.05222.x
SIRS, We thank Dr Guerra and Dr Gisbert for their
com-ment on our article.1, 2 As underscored by the authors, no definite conclusions can be drawn from our findings. However, despite small sample size, no positive trends were observed in our case series whatever the subgroup of patients considered.
Based on our results, we thus decided to stop using methotexate for treating psoriasiform lesions associated with antitumour necrosis factor (TNF) therapy in IBD in our centre. We do not believe that anti-TNF switching is a confounding factor when interpreting our data, as sug-gested by Guerra and Gisbert. This reflects clinical prac-tice, as continuation of anti-TNF treatment is needed in the vast majority of IBD patients.
Consistently, anti-TNF therapy withdrawal was associ-ated with a need for surgery in two patients. Our find-ings simply confirm a drug class effect for these psoriasiform lesions. If methotrexate was effective in treating skin lesions induced by anti-TNF therapy, by definition, it should be effective in patients with ongoing anti-TNF treatment. This was not the case in our eight patients. Finally, our results further highlight that the mechanisms underlying these skin lesions likely differ from those associated with psoriasis vulgaris.
In conclusion, despite the limitations to our study and pending large prospective studies addressing this issue, we cannot recommend treating anti-TNF therapy-associ-ated psoriasiform lesions with methotrexate in IBD patients. These skin lesions may require different thera-peutic approaches than methotrexate. This will also require further investigation.
ACKNOWLEDGEMENT
The authors’ declarations of personal and financial inter-ests are unchanged from those in the original article.2
REFERENCES
1. Guerra I, Gisbert JP. Letter: anti-TNFs and psoriasis - friends or foes? Aliment Pharmacol Ther 2012;36: 497.
2. Buisson A, Cuny JF, Barbaud A, et al. Methotrexate for psoriasiform lesions associated with anti-tumour necrosis factor therapy in inflammatory bowel disease. Aliment Pharmacol Ther 2012;35: 1175–80.
Letter: in
fliximab and adalimumab in the
management of Crohn
’s disease – are
they really comparable?
A. Lopez-Sanroman* & J. P. Gisbert†
*Servicio de Gastroenterología, Hospital Ramón y Cajal, Madrid, Spain.
†Servicio de Gastroenterología y Centro de Investigación Biomédica
en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain.
E-mail: gisbert@meditex.es doi:10.1111/j.1365-2036.2012.05185.x
SIRS, Analyses on the performance of newer therapies in
the real world are always interesting. Moreover,
head-to-head comparisons of two drugs licensed for the same indication are rarely promoted by manufacturers. This is why the recent contribution of Zorzi et al. is very wel-come.1 The authors compared the respective efficacies of infliximab and adalimumab in the management of Crohn’s disease, concluding that they are roughly similar.
Although we appreciate the interest of the authors’ experi-ence, we would like to add some comments. A randomised clinical trial retains its strength when compared to a clinical series. In this respect, there are some issues in the article by Zorzi et al. that affect the comparability of both groups of therapy. Firstly, which anti-TNF to use was decided on an individual basis, which may induce a significant bias. Sec-ondly, the populations treated were not comparable, affecting factors that may influence the response to therapy including longer disease duration, associated perianal disease (over
498 Aliment Pharmacol Ther 2012; 36: 497-501
ª 2012 Blackwell Publishing Ltd
