Retrospective Analysis of Demographic and Clinical Data of Psoriasis Patients Who Developed Inflammatory Bowel Disease Under Secukinumab and Ixekizumab Treatment
Keywords:
IL-17A inhibitors, Inflammatory Bowel Disease, Ixekizumab, Psoriasis, SecukinumabAbstract
Introduction: The aim of this study was to retrospectively investigate the frequency of inflammatory bowel disease (IBD) and the demographic and clinical characteristics of psoriasis (PsO) patients exposed to IL-17A inhibitors.
Method: Health data of 2,264 PsO patients who had received at least one dose of ixekizumab or secukinumab were retrospectively reviewed. Demographic data, clinical characteristics, symptoms consistent with IBD and confirmed IBD diagnoses of the patients were collected. Among the patients presenting with IBD-related symptoms during follow-up, those diagnosed with IBD after gastroenterology consultation were additionally recorded.
Results: Among the 2,264 patients, 28 individuals (1.2%) reported gastrointestinal symptoms consistent with IBD (diarrhea, abdominal pain, bloody stool). The median time from initiation of IL-17A inhibitor therapy to symptom onset was 5.8 months. Of the symptomatic patients, 18 were female (64.3%) and 10 were male (35.7%). Fifteen patients (53.6%) were secukinumab users, and 13 (46.4%) were ixekizumab users; there was no significant difference between the drug groups in terms of symptom frequency (P=0.67). Following gastroenterological evaluation, seven patients (0.3%) were diagnosed with IBD, four of whom were secukinumab and three were ixekizumab users (P=0.72). Among the confirmed cases, three had ulcerative colitis and four had Crohn’s disease.
Conclusion: Gastrointestinal symptoms were observed in 1.2% of the study population, while the rate of confirmed IBD after gastroenterological evaluation was 0.3%. This rate is similar to that of the general population. The distribution of ulcerative colitis and Crohn’s disease cases was equal between ixekizumab and secukinumab users. Monitoring for gastrointestinal symptoms during the first six months of treatment is important.
References
Bianchi E, Rogge L. The IL-23/IL-17 pathway in human chronic inflammatory diseases: new insight from genetics and targeted therapies. Genes Immun. 2019;20(5):415-425. DOİ: 10.1038/s41435-019-0067-y
Onishi RM, Gaffen SL. Interleukin-17 and its target genes: mechanisms of interleukin-17 function in disease. Immunology. 2010;129(3):311-321. DOI: 10.1111/j.1365-2567.2009.03240.x
Gálvez J. Role of Th17 cells in the pathogenesis of human IBD. ISRN Inflamm. 2014;2014:928461. DOI: 10.1155/2014/928461
Ali AK, Torosian A, Porter C, Bloomfeld RS, Feldman SR. New onset inflammatory bowel disease in patient treated with secukinumab: case report and review of literature. Dermatol Ther. 2021;34(6):e15151. Doi:10.1111/dth.15151
Fieldhouse KA, Ukaibe S, Crowley EL, Khanna R, O’Toole A, Gooderham M. JInflammatory bowel disease in patients with psoriasis treated with interleukin-17 inhibitors. Drugs Context. 2020;9:2020-7-2. DOI: 10.7573/dic.2020-2-1
Achufusi TG, Harnee PS, Rawlins S. A rare case of new-onset ulcerative colitis following initiation of secukinumab. Case Rep Med. 2019;2019:2975631. DOI: 10.1155/2019/2975631
Ehrlich D, Jamaluddin N, Pisegna J, Padua D. A challenging case of severe ulcerative colitis following the initiation of secukinumab for ankylosing spondylitis. Case Rep Gastrointest Med. 2018;2018:9679287. DOI: 10.1155/2018/9679287
Wang J, Bhatia A, Cleveland NK, et al. Rapid onset of inflammatory bowel disease after receiving secukinumab infusion. ACG Case Rep J. 2018;5:e56. DOI: 10.14309/crj.2018.56
Schreiber S, Colombel JF, Feagan BG, et al. Incidence rates of inflammatory bowel disease in patients with psoriasis, psoriatic arthritis and ankylosing spondylitis treated with secukinumab: a retrospective analysis of pooled data from 21 clinical trials. Ann Rheum Dis. 2019;78(4):473-479. DOI: 10.1136/annrheumdis-2018-214273
Burisch J, Eigner W, Schreiber S, et al. Risk for development of inflammatory bowel disease under inhibition of interleukin 17: a systematic review and meta-analysis. PLoS One. 2020;15(5):e0233781. DOI: 10.1371/journal.pone.0233781
Fauny M, Moulin D, D'Amico F, et al. Paradoxical gastrointestinal effects of interleukin-17 blockers. Ann Rheum Dis. 2020;79(9):1132-1138. DOI: 10.1136/annrheumdis-2020-217927
Petitpain N, D’amico F, Yelehe‐Okouma M, et al. IL-17 inhibitors and inflammatory bowel diseases: a postmarketing study in VigiBase. Clin Pharmacol Ther. 2021;110(1):159-168. DOI: 10.1002/cpt.2155
Goepfert A, Lehmann S, Wirth E, Rondeau JM. The human IL-17A/F heterodimer: a two-faced cytokine with unique receptor recognition properties. Sci Rep. 2017;7(1):8906. DOI: 10.1038/s41598-017-08360-9
Fu Y, Lee CH, Chi CC. Association of psoriasis with inflammatory bowel disease: a systematic review and meta-analysis. JAMA Dermatol. 2018;154(12):1417-1423. DOI: 10.1001/jamadermatol.2018.3631
Targan SR, Feagan B, Vermeire S, et al. A randomized, double-blind, placebo-controlled phase 2 study of brodalumab in patients with moderate-to-severe Crohn’s disease. Am J Gastroenterol. 2016;111(11):1599-1607. DOI: 10.1038/ajg.2016.298
Hueber W, Sands BE, Lewitzky S, et al. Secukinumab, a human anti-IL-17A monoclonal antibody, for moderate to severe Crohn’s disease: unexpected results of a randomized, double-blind placebo-controlled trial. Gut. 2012;61(12):1693-1700. DOI: 10.1136/gutjnl-2011-301668
Kobayashi T, Okamoto S, Hisamatsu T, et al. IL-23 differentially regulates the Th1/Th17 balance in ulcerative colitis and Crohn’s disease. Gut. 2008;57(12):1682-1689. DOI: 10.1136/gut.2007.135053
Eppinga H, Poortinga S, Thio HB, et al. Prevalence and phenotype of concurrent psoriasis and inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(10):1783-1789. DOI: 10.1097/MIB.0000000000001169
GBD 2017 Inflammatory Bowel Disease Collaborators. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(1):17-30. DOI: 10.1016/S2468-1253(19)30333-4
Alinaghi F, Tekin HG, Burisch J, Wu JJ, Thyssen JP, Egeberg A. Global prevalence and bidirectional association between psoriasis and inflammatory bowel disease a systematic review and meta-analysis. J Crohns Colitis. 2020;14(3):351-360. DOI: 10.1093/ecco-jcc/jjz152
Yamada A, Wang J, Komaki Y, Komaki F, Micic D, Sakuraba A .Risk of new onset IBD with the use of anti-interleukin-17 agents: a systematic review and meta-analysis. Aliment Pharmacol Ther. 2019;50(4):373-385. DOI: 10.1111/apt.15397
Wright S, Alloo A, Strunk A, Garg A. Real-world risk of new-onset inflammatory bowel disease among patients with psoriasis exposed to interleukin 17 inhibitors. J Am Acad Dermatol. 2020;83(2):382-387. DOI: 10.1016/j.jaad.2020.04.010
Caron B, Jouzeau JY, Miossec P, et al. Gastroenterological safety of IL-17 inhibitors: a systematic literature review. Expert Opin Drug Saf. 2022;21(2):223-239. DOI: 10.1080/14740338.2021.1960981
Onac IA, Clarke BD, Tacu C. Secukinumab as a potential trigger of inflammatory bowel disease in ankylosing spondylitis or psoriatic arthritis patients. Rheumatology (Oxford). 2021;60(11):5233-5238. DOI: 10.1093/rheumatology/keab193
Deng Z, Wang S, Wu C, Wang C. IL-17 inhibitor-associated inflammatory bowel disease: a study based on literature and database analysis. Front Pharmacol. 2023;14:1124628. doi:10.3389/fphar.2023.1124628
Cepero-Jimenez CM, Santiago-Rivera L. New-onset ulcerative colitis associated to ixekizumab. Am J Gastroenterol. 2024;119(12 Suppl):S28. DOI: 10.14309/01.ajg.0001082952.32829.7b
Masic N, Anjie SI, Sungur, R. New-onset inflammatory bowel disease is uncommon in patients with psoriasis, psoriatic arthritis and spondylarthritis treated with secukinumab: a retrospective cohort study in a tertiary centre. J Crohns Colitis. 2024;18(Suppl 1):i2230. Doi:10.1093/ecco-jcc/jjad212.1250
Letarouilly JG, Pham T, Pierache A. New-onset inflammatory bowel diseases among IL-17 inhibitor-treated patients: results from the case–control MISSIL study. Rheumatology (Oxford). 2022;61(7):2848-2855. DOI: 10.1093/rheumatology/keab819
Li R, Lei H, Wang C, Liu X. Clinical features, treatment, and prognosis of secukinumab-induced inflammatory bowel disease. Eur J Med Res. 2025;30(1):37. DOI: 10.1186/s40001-025-02295-y
Maxwell JR, Yadav R, Rossi RJ. IL-18 bridges innate and adaptive immunity through IFN-γ and the CD134 pathway. J Immunol. 2006;177(1):234-245. DOI: 10.4049/jimmunol.177.1.234
Ogawa A, Andoh A, Araki Y, Bamba T, Fujiyama Y. Neutralization of interleukin-17 aggravates dextran sulfate sodium-induced colitis in mice. Clin Immunol. 2004;110(1):55-62. DOI: 10.1016/j.clim.2003.09.013
Alsakarneh S, Al Ta’ani O, Aburumman R, Mikhail I, Hashash JG, Farraye F. Risk of de novo inflammatory bowel disease in patients with psoriasis and psoriatic arthritis treated with IL-17A inhibitors: a population-based study. Aliment Pharmacol Ther. 2025;62(3):321-332. DOI: 10.1111/apt.70139
Colombo D, Cassano N, Bellia G, Vena GA. World Journal of. World J. 2014;3(3):36-44. doi:10.5314/wjd.v3.i3.36
Dai H, Xu C, Wang Y. Secukinumab-induced Crohn's disease in a psoriasis patient: a case report highlighting paradoxical reactions to IL-17 inhibition. Front Immunol. 2025;16:1628461. DOI: 10.3389/fimmu.2025.1628461
Bratborska A, Jałowska M, Bowszyc-Dmochowska M, Kowalczyk MJ, Adamska K. Misfortunes never come alone: melanoma and ulcerative colitis after biologic therapy in a psoriatic patient - a case report and literature review. Front Immunol. 2025;16:1651517. DOI: 10.3389/fimmu.2025.1651517
Grümme L, Dombret S, Knösel T, Skapenko A, Schulze-Koops H. Colitis induced by IL-17A inhibitors. Clin J Gastroenterol. 2024;17(2):263-270. DOI: 10.1007/s12328-023-01893-9
Albayrak F, Gür M, Karataş A, Koca SS, Kısacık B. Is the use of secukinumab after anti-TNF therapy greater than expected for the risk of developing inflammatory bowel disease? Reumatol Clin. 2024;20(3):123-127. DOI: 10.1016/j.reumae.2023.11.002
Orzan OA, Țieranu CG, Olteanu AO, et al. An insight on the possible association between inflammatory bowel disease and biologic therapy with IL-17 inhibitors in psoriasis patients. Pharmaceutics. 2023;15(8):2171. DOI: 10.3390/pharmaceutics15082171
Nehring P, Przybyłkowski A. Is psoriasis treatment a risk factor for inflammatory bowel disease? Pharm Med. 2020;34(4):257-262. DOI: 10.1007/s40290-020-00340-1
Shani U, Ben-Shabat N, Qassem R. The association between psoriasis, psoriasis severity, and inflammatory bowel disease: a population-based analysis. Ther Adv Gastroenterol. 2024;17:17562848241227037. DOI: 10.1177/17562848241227037
Smith MK, Pai RK, Russo PA, et al. Crohn's-like disease in a patient exposed to anti-interleukin-17 blockade (ixekizumab) for the treatment of chronic plaque psoriasis: a case report. BMC Gastroenterol. 2019;19(1):1-6. DOI: 10.1186/s12876-019-1067-0
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