Inflammatory bowel disease in patients with psoriasis treated with interleukin-17 inhibitors.
Inflammatory bowel disease in patients with psoriasis treated with interleukin-17 inhibitors.
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DOI：
10.7573/dic.2020-2-1
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发表时间：
2020-01-01
期刊：
影响因子：
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通讯作者：
Gooderham, Melinda J
中科院分区：
文献类型：
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作者：
Fieldhouse, Keira A;Ukaibe, Samantha;Gooderham, Melinda J
背景：白介素17(IL-17)抑制剂为银屑病和银屑病关节炎患者提供了一种极好的治疗选择，对皮肤清除和关节改善具有很高的疗效。这组生物制剂的临床试验也证实了安全性；然而，文献中报道的炎症性肠病(IBD)恶化或诱发的病例很少。尚未建立任何因果关系。当研究IL-17抑制剂治疗IBD时，没有发现任何益处，一些患者的病情恶化。IBD在银屑病患者中更为常见，因此，目前尚不清楚这些药物是否会导致新发的IBD，或者报告的接受IL-17治疗的患者中的IBD病例是否由于这一可能已有潜在或亚临床疾病的易感人群的背景风险。方法/结果：在PubMed和Google Scholar中搜索术语“IL-17抑制物”、“ixekizumab”、“sukkinumab”、“brodalab”和“炎症性肠病”、“溃疡性结肠炎”和“克罗恩病”。与上市后药物警戒数据一起，在文献中发现了新发或加重的IBD病例。本文将对这些病例进行综述。结论：IL-17抑制剂对银屑病和银屑病关节炎的治疗已被证明是有效的，具有很强的安全性。然而，文献中报道了服用IL-17抑制剂的患者发生和恶化IBD的罕见病例，这突显了在治疗这一人群时选择适当的患者和治疗选择的必要性。
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 new-onset 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.