Interleukin-12/23 and Interleukin-23 Inhibitors for the Treatment of Cutaneous Crohn's Disease: A Case Series From a Multi-Institutional Registry

Background: Cutaneous Crohn's disease (CCD) is a granulomatous condition of the skin discontiguous from the gastrointestinal tract. Cutaneous disease rarely correlates with intestinal disease and often requires separate treatment. While the use of interleukin-12/23 (IL-12/IL-23) and interleukin-23 (IL-23) inhibitors is FDA-approved for intestinal Crohn's disease (CD), there is limited data for CCD. We retrospectively reviewed the clinical features of 24 cases of CCD treated with risankizumab as monotherapy, ustekinumab as monotherapy, or ustekinumab in combination with vedolizumab from seven academic institutions across the United States. Objectives: The objective of this study was to evaluate the impact of IL-12/23 or IL-23 inhibitor therapy on CCD independent of intestinal disease. Methods: Patients were identified by retrospective review of the electronic health record including histopathologic diagnosis consistent with CCD. At least one visit with a dermatologist between 2000 and 2020 was required. Chart review collected demographic, clinical and histologic data. ResultsWe identified 24 adult and paediatric patients with CCD treated with IL-12/IL-23 inhibitor therapy. Most patients were White (21/24, 88%), female (20/24, 83%), had intestinal CD (19/24, 79%), were diagnosed with intestinal CD before CCD diagnosis (18/24, 75%), and were on biologic therapy before CCD diagnosis (16/24, 67%). Most patients failed to respond to treatment with anti-tumour necrosis alpha (anti-TNF) therapy before IL-12/IL-23 inhibitor therapy (22/24, 92%). Of the 24 patients treated with ustekinumab, less than half (7/24, 29%) were simultaneously treated with vedolizumab. Four adult patients (4/24, 17%) were treated with risankizumab monotherapy. At the date of the last follow-up with a dermatologist, over a third (8/24, 33%) of patients' skin was reported as complete clearance by physician note. Conclusions: We propose that IL-12/IL-23 and IL-23 inhibitor therapy be considered as therapy for the treatment of TNF-blockade refractory CCD.