Spotlight on the treatment armamentarium of concomitant psoriasis and inflammatory bowel disease: a systematic review

Background Psoriasis and inflammatory bowel diseases share common immunological pathomechanisms and therefore similar treatment options. Objective To assess already existing therapies and their efficacy versus adverse effects and paradoxical reactions in patients presenting with either disease or both. Data sources A systematic search of the PubMed and Science.gov databases was performed for the period 2018-2020. Only articles in English were selected. Search terms included a combination of keywords: adalimumab, infliximab, etanercept, golimumab, certolizumab, ustekinumab, guselkumab, vedolizumab, secukinumab, ixekizumab, brodalumab, acitretin, cyclosporine, methotrexate, apremilast, mycophenolate mofetil, sulfasalazine, hydroxyurea, azathioprine, 6-thioguanine, tacrolimus, leflunomide and fumaric acid esters in combination with each of the following: paradoxical, psoriasis, psoriatic arthritis, inflammatory bowel disease, Crohn's disease, ulcerative colitis. Other potentially relevant articles were identified by manually checking the references of the included literature. Study selection Recent reviews and meta-analyses, pooled analyses, cohort studies, observational studies, care reports were all included. Conclusions Psoriasis and IBD can be treated concurrently as they share common inflammatory pathways. TNF-alpha inhibitors and IL-12/23 have been successful in treating both psoriasis and IBD. IL-17 inhibitors are recognized treatments for psoriasis but have the potential to exacerbate IBD. Newer molecules require further clinical trials and real-life studies in order to confirm their efficacy and safety.