A significant association has been demonstrated between psoriasis and inflammatory bowel disease (IBD), and certain treatments for patients with psoriasis may potentially worsen or induce IBD, according to results of a systematic review published in the Journal of the American Academy of Dermatology.
Of the 2282 articles that were identified, a total of 132 were selected for examination. The review showed that infliximab and adalimumab therapy have demonstrated efficacy in patients with psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn disease.
Moreover, ustekinumab therapy has shown efficacy among patients with psoriasis, psoriatic arthritis, and Crohn disease. Treatment with certolizumab has demonstrated efficacy in those with psoriatic arthritis and Crohn disease, and guselkumab therapy has demonstrated efficacy among individuals with psoriatic arthritis and ulcerative colitis.
Although treatment with etanercept, secukinumab, brodalumab, and ixekizumab has been shown to be effective among patients with psoriasis and psoriatic arthritis, use of these agents may actually exacerbate or induce symptoms of IBD and Crohn disease.
The investigators concluded that because of the possible association of interleukin 17 inhibitors with IBD, caution should be exercised when these agents are used in this population. They cited limitations with respect to extrapolating the existing psoriasis clinical trial data to assess potential risk for IBD exacerbations.
Risk for IBD in the larger overall patient population compared with a population that comprises only those with a history of IBD may underestimate the true risk. Rigorous study of long-term data is warranted to determine the nature of any possible association.
Whitlock SM, Enos CW, Armstrong AW, et al. Management of psoriasis in patients with inflammatory bowel disease: From the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2018;78(2):383-394.