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TOPLINE:

In patients with psoriasis or ankylosing spondylitis, the use of interleukin (IL)-17A inhibitors, particularly secukinumab, was associated with an increased risk for inflammatory bowel disease (IBD) compared with those treated with apremilast.

METHODOLOGY:

• Researchers conducted a retrospective study using a database that included patients covered under various health insurance plans across the United States to assess the association between the use of IL-17A inhibitors and the risk for IBD.
• They compared the risk for IBD between patients with psoriasis or ankylosing spondylitis who initiated IL-17A inhibitors and those who initiated apremilast between January 2015 and December 2024.
• The anti–IL-17A group included 13,216 patients who initiated ixekizumab or secukinumab (mean age, 49.9 years; 54.9% women) who were propensity score–matched to 13,216 patients who initiated apremilast (mean age, 49.4 years; 54.6% women).
• The primary outcome was the first diagnosis of IBD, occurring at least 1 month post-initiation of therapy and extending through a lifetime of follow-up.

TAKEAWAY:

• Overall, 142 patients in the anti–IL-17A group vs 60 patients in the apremilast group developed IBD (adjusted hazard ratio [aHR], 2.50; P < .0001), with an increased risk observed for both Crohn’s disease (aHR, 3.95; P < .0001) and ulcerative colitis (aHR, 1.78; P = .0023).
• Among IL-17A inhibitors, secukinumab was associated with an increased risk for IBD (aHR, 2.82; P < .0001), but not ixekizumab.
• Both men and women had an increased risk for IBD (P < .0001 and P = .0003, respectively) and Crohn’s disease (P < .0001 for both), but not ulcerative colitis, with the use of IL-17A inhibitors.
• The risk for IBD was highest for patients older than 60 years in the anti– IL-17A group (P < .0001).

IN PRACTICE:

“The exact link between IL-17 inhibitors and IBD remains unclear, and no causal relationship has been established, but it may involve IL-17’s protective role in the gastrointestinal tract,” the authors wrote.

SOURCE:

This study was led by Saqr Alsakarneh, MD, MSc, University of Missouri-Kansas City, Kansas City, Missouri, and Omar Al Ta’ani, MD, Allegheny Health Network, Pittsburgh. It was published online on April 7, 2024, in Alimentary Pharmacology and Therapeutics.

LIMITATIONS:

The clinical spectrum of IBD may not be fully captured by the use of diagnostic codes. Underrepresentation of certain ethnicities in the database may have limited the generalizability of the findings. Healthcare providers may have refrained from prescribing the inhibitors to high-risk patients, potentially underestimating the true number of affected individuals.

DISCLOSURES:

This study did not receive any specific funding. One author reported receiving consulting fees from multiple pharmaceutical companies, including Astellas and Pfizer. Another author reported being an advisory board member.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.