Ulcerative colitis induced by ixekizumab: a case report

Marin, Marta; Alzueta, Natalia; Pío, María; Gascón, Ana; Castresana, Marta

doi:10.1136/ejhpharm-2019-002016

Cited by 7 publications

(14 citation statements)

References 8 publications

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“…A total of 29 studies were identified in the published literature, including 25 case reports ( Ehrlich et al, 2018 ; Grimaux et al, 2018 ; Paul et al, 2018 ; Wang et al, 2018 ; Achufusi et al, 2019 ; Grossberg, 2019 ; Haidari et al, 2019 ; Johnston and Veettil, 2019 ; Philipose et al, 2019 ; Rodriguez et al, 2019 ; Shimizu et al, 2019 ; Smith et al, 2019 ; Darch et al, 2020 ; Fieldhouse et al, 2020 ; Marin et al, 2020 ; Merino Gallego et al, 2020 ; Nazarian et al, 2020 ; Ali et al, 2021 ; Mu et al, 2021 ; Obeidat and Murakami, 2021 ; Ma et al, 2022 ; Sykaras et al, 2022 ; Kukol et al, 2019 ; Nallapeta et al, 2019 ; Sethi et al, 2019 ) and 4 case series ( Fobelo et al, 2018 ; Shukla et al, 2018 ; Vernero et al, 2019 ; Lee et al, 2020 ); a total of 34 cases raised evidence of IBD occurrence during therapy with SEC (27 cases, 79.4%) and IXE (7 cases, 20.6%). Characteristics of the included cases are presented in Table 4 .…”

Section: Resultsmentioning

confidence: 99%

IL-17 inhibitor-associated inflammatory bowel disease: A study based on literature and database analysis

Deng

Wang

et al. 2023

Front. Pharmacol.

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Objective: Few real-world studies have shown clear association between interleukin (IL)-17 inhibitors and inflammatory bowel disease (IBD) onset. This study investigated the reporting prevalence and evaluated the clinical features and management of IL-17 inhibitor-related IBD events.Methods: We used the US FDA Adverse Event Reporting System database and retrieved data, from 2015 to 2022, on IL-17 inhibitors to identify gastrointestinal inflammatory events and conduct disproportionality analyses by estimating the reporting odds ratios (RORs) and corresponding 95% confidence intervals (CIs). Furthermore, case reports and case series, from 2015 to 30 November 2022, on IBD induced by IL-17 inhibitors were collected for retrospective analysis.Results: A total of 388 cases of primary suspected IL-17 inhibitor-associated gastrointestinal events were reported (268 IBD and 120 colitis), including 348 cases involving secukinumab (SEC), 36 cases involving ixekizumab (IXE), and 4 cases involving brodalumab (BRO). Statistically significant reporting rates of total IBD events were observed for SEC and IXE (ROR = 2.13, 95% CI [1.96-2.30] and ROR = 2.79, 95% CI [2.39-3.27], respectively), whereas BRO did not trigger a safety signal. Twenty-nine studies, which included 34 cases, showed evidence of IBD, following SEC (79.4%) and IXE (20.6%) treatment. The median age was 42 years; typical initial symptoms included diarrhea (90.9%), abdominal pain (57.6%), bloody diarrhea (51.5%), and fever (36.4%). The median time to onset of IBD symptoms was 2.9 months. Some cases were accompanied by elevated white blood cell (WBC) count (87.5%), erythrocyte sedimentation rate (ESR; 85.7%), C-reactive protein (CRP; 100%), and fecal calprotectin (FC; 100%). Cessation of IL-17 inhibitors plus treatment with corticosteroids and TNF antagonists, as either monotherapy or in combination, could lead to complete clinical remission. The median time to remission after IL-17 inhibitor discontinuation was 4 weeks.Conclusion: IL-17 inhibitor treatment is associated with exacerbation and new onset of IBD and colitis. Obtaining a detailed patient history before initiation of treatment and monitoring gastrointestinal symptoms and intestinal inflammatory biomarkers during IL-17 inhibitor treatment is important for safe use of these drugs.

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Section: Resultsmentioning

confidence: 99%

IL-17 inhibitor-associated inflammatory bowel disease: A study based on literature and database analysis

Deng

Wang

et al. 2023

Front. Pharmacol.

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“…In 2021, Marin M et al reported the case of a case of a 76-year-old Spanish woman who presented with acute self-limited colitis after receiving ten doses of ixekizumab for her pre-existing, long-standing chronic plaque psoriasis [ 65 ]. She had previously been treated with methotrexate 20 mg, acitretin 25 mg, both of them being withdrawn due to intolerance, and adalimumab 40 mg subcutaneously for two years [ 65 ]. The patient was then switched to ustekinumab 45 mg every 12 weeks due to loss of therapeutic response to the TNF-alpha inhibitor [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

“…She had previously been treated with methotrexate 20 mg, acitretin 25 mg, both of them being withdrawn due to intolerance, and adalimumab 40 mg subcutaneously for two years [ 65 ]. The patient was then switched to ustekinumab 45 mg every 12 weeks due to loss of therapeutic response to the TNF-alpha inhibitor [ 65 ]. Nevertheless, after five doses of ustekinumab, the patient developed bullous pemphigoid, possibly in the context of biologic therapy with the IL-12/23 inhibitor [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

“…The patient was then switched to ustekinumab 45 mg every 12 weeks due to loss of therapeutic response to the TNF-alpha inhibitor [ 65 ]. Nevertheless, after five doses of ustekinumab, the patient developed bullous pemphigoid, possibly in the context of biologic therapy with the IL-12/23 inhibitor [ 65 ]. The patient was then switched to ixekizumab, 80 mg subcutaneously every 4 weeks after a previous induction regimen [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

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An Insight on the Possible Association between Inflammatory Bowel Disease and Biologic Therapy with IL-17 Inhibitors in Psoriasis Patients

Orzan,

Țieranu,

Olteanu

et al. 2023

Pharmaceutics

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Psoriasis is a chronic, inflammatory, multisystemic disease which affects approximately 2–3% of the population globally, whose onset is triggered by genetic and environmental factors which activate both dendritic cells and keratinocytes, resulting in the production of proinflammatory cytokines such as tumor necrosis factor alpha, interleukin 17, interleukin 23, interleukin 22, and interleukin 1β. An in-depth understanding of the pathophysiology of psoriasis led to significant advances in the development of safe and efficient novel therapeutic options, with four classes of biologic therapy being approved for the management of moderate to severe psoriasis: tumor necrosis factor alpha inhibitors, interleukin 23 inhibitors, anti-interleukin 12/23 agents, anti-interleukin 17 agents, as well as small-molecule inhibitors, such as apremilast. Psoriasis is associated with comorbid conditions, namely psoriatic arthritis, cardiovascular disease, metabolic syndrome, psychiatric disorders, malignancy, as well as inflammatory bowel disease. For patients affected by both psoriasis and inflammatory bowel disease, there is a strong recommendation to avoid IL-17 inhibitors since they may play a part in the exacerbation of the gastrointestinal disease. Our aim was to perform a thorough literature review regarding the development of inflammatory bowel disease lesions in psoriasis patients treated with IL-17 inhibitors, along with a case presentation to emphasize the need for close follow-up of these patients.

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“…Another case report also presented a patient with psoriasis who was treated with ixekizumab and after 12 weeks of the induction period developed diarrheal illness and rectal bleeding [117]. Marin et al reported a case of acute selflimited UC occurring in a patient treated with ixekizumab for psoriasis, and the colitis was quickly resolved after treatment withdrawal [118]. For patients with psoriasis and IBD, anti-IL-17 agents should be avoided.…”

Section: Il-17 Inhibitorsmentioning

confidence: 99%

Biologic and Small-Molecule Therapies for Moderate-to-Severe Psoriasis: Focus on Psoriasis Comorbidities

Jiang

Chen

et al. 2023

BioDrugs

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Psoriasis is a systemic immune-mediated disease associated with an increased risk of comorbidities, such as psoriatic arthritis, cardiovascular disease, metabolic syndrome, inflammatory bowel disease, psychiatric disorders, and malignancy. In recent years, with the advent of biological agents, the efficacy and safety of psoriasis treatments have dramatically improved. Presently, tumor necrosis factor-α inhibitors, interleukin-17 inhibitors, interleukin-12/23 inhibitors, and interleukin-23 inhibitors are approved to treat moderate-to-severe psoriasis. Small-molecule inhibitors, such as apremilast and deucravacitinib, are also approved for the treatment of psoriasis. Although it is still unclear, systemic agents used to treat psoriasis also have a significant impact on its comorbidities by altering the systemic inflammatory state. Data from clinical trials and studies on the safety and efficacy of biologics and small-molecule inhibitors provide important information for the personalized care and treatment for patients with psoriasis. Notably, treatment with interleukin-17 inhibitors is associated with new-onset or exacerbations of inflammatory bowel disease. In addition, great caution needs to be taken when using tumor necrosis factor-α inhibitors in patients with psoriasis with concomitant congestive heart failure, multiple sclerosis, and malignancy. Apremilast may induce weight loss as an adverse effect, presenting also with some beneficial metabolic actions. A better understanding of the characteristics of biologics and small-molecule inhibitors in the treatment of psoriasis comorbidities can provide more definitive guidance for patients with distinct comorbidities.

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Ulcerative colitis induced by ixekizumab: a case report

Cited by 7 publications

References 8 publications

IL-17 inhibitor-associated inflammatory bowel disease: A study based on literature and database analysis

IL-17 inhibitor-associated inflammatory bowel disease: A study based on literature and database analysis

An Insight on the Possible Association between Inflammatory Bowel Disease and Biologic Therapy with IL-17 Inhibitors in Psoriasis Patients

Biologic and Small-Molecule Therapies for Moderate-to-Severe Psoriasis: Focus on Psoriasis Comorbidities

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