Inflammatory bowel disease in patients with psoriasis treated with interleukin-17 inhibitors

Article Details

Authors
Keira A Fieldhouse Bsc, Samantha Ukaibe BSc, Erika L Crowley BSc, MSc, Reena Khanna MD, MSc, FRCPC, Ashley O’Toole MD, MHSc, FRCPC, Melinda J Gooderham MD, MSc, FRCPC

Article Type
Review

DOI
10.7573/dic.2020-2-1

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Abstract

Background: Interleukin 17 (IL-17) inhibitors provide an excellent treatment option for patients with psoriasis and psoriatic arthritis, resulting in high levels of efficacy for skin clearance and joint improvement. Safety has also been established in clinical trials for this group of biologic agents; however, rare case reports of exacerbation or induction of inflammatory bowel disease (IBD) have been reported in the literature. No causal relationship has been established. When IL-17 inhibitors were investigated for the management of IBD, no benefit was found and worsening of disease was noted for some patients. IBD is more common in patients with psoriasis and, therefore, it remains unknown if these drugs cause de novo IBD or if the reported cases of IBD in patients on IL-17 therapy is due to the background risk in this predisposed population who may have already had an underlying or subclinical disease.

Methods/Results: A literature search was conducted for the terms ‘IL-17 inhibitor,’ ‘ixekizumab,’ ‘secukinumab,’ ‘brodalumab’ and ‘inflammatory bowel disease,’ ‘ulcerative colitis,’ and ‘Crohn’s disease’ in PubMed and Google Scholar. Cases of newonset or exacerbation of IBD were identified in the literature along with postmarketing pharmacovigilance data. These cases will be reviewed in this paper.

Conclusions: IL-17 inhibitors have proven efficacy for the treatment of psoriasis and psoriatic arthritis with a strong safety profile. However, rare cases of IBD onset and exacerbation in patients on IL-17 inhibitors have been reported in the literature, highlighting the need to select patients and therapeutic choices appropriately when treating this population.

Keywords: brodalumab, Crohn’s disease, IL-17 inhibitor, inflammatory bowel disease, ixekizumab, secukinumab, ulcerative colitis

Citation: Fieldhouse KA, Ukaibe S, Crowley EL, Khanna R, O’Toole A, Gooderham MJ. Inflammatory bowel disease in patients with psoriasis treated with interleukin-17 inhibitors. Drugs in Context 2020; 9: 2020-2-1. DOI: 10.7573/dic.2020-2-1

Contributions: KAF was the principle author in the writing of the manuscript with content provided by SU and MJG. EC, RK, AO and MJG provided editing and proofreading of the manuscript. MJG and EC supervised the preparation of the manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: Keira A Fieldhouse, Samantha Ukaibe and Erika L Crowley have no conflicts to disclose. Reena Khanna has been a speaker advisory board member, and or clinical investigator for AbbVie, Encycle, Innomar, Janssen, Merck, Pfizer, Pendopharm, Robarts Clinical Trials, Roche/Genetec, Shire, Takeda. Ashley O’Toole has been a speaker or a sub-investigator for AbbVie, Arcutis, Boehringer Ingleheim, Celgene, Galderma, Janssen, Kyowa Kirin, Leo Pharma, Medimmune, Novartis, Pfizer, Regeneron, Sanofi Genzyme, UCB, and Valeant. Melinda J Gooderham has been a speaker, advisory board member and/or clinical investigator for AbbVie, Akros, Amgen, Arcutis, Boehringer Ingleheim, Celgene, Dermira, Galderma, GSK, Janssen, Kyowa Kirin, Kythera, Leo Pharma, Medimmune, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, UCB, and Valeant/Bausch. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at https://www.drugsincontext.com/wp-content/uploads/2020/03/dic.2020-2-1-COI.pdf

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2020 Fieldhouse KA, Ukaibe S, Crowley EL, Khanna R, O’Toole A, Gooderham MJ. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Fieldhouse KA, Ukaibe S, Crowley EL, Khanna R, O’Toole A, Gooderham MJ. https://doi.org/10.7573/dic.2020-2-1. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/inflammatory-bowel-disease-in-patients-with-psoriasis-treated-with-interleukin-17-inhibitors

Correspondence: Melinda J Gooderham, SKiN Centre for Dermatology, 775 Monaghan Road South, Peterborough, ON K9J 5K2, Canada. mgooderham@centrefordermatology.com

Provenance: invited; externally peer reviewed.

Submitted: 16 February 2020; Peer review comments to author: 2 March 2020; Revised manuscript received: 26 March 2020; Accepted: 27 March 2020; Publication date: 21 April 2020.

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