Ixekizumab

Ulcerative colitis

Dermatology

Infliximab

Ustekinumab

Vedolizumab

Ankylosing spondylitis

Disease

Secukinumab

Psoriasis

Exacerbation

Internal medicine

Psoriatic arthritis

Rheumatology

Immunology

Arthritis

Medicine

Annals of the Rheumatic Diseases

Secukinumab, ixekizumab and brodalumab are monoclonal antibody therapies that inhibit interleukin (IL)-17 activity and are widely used for the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis. The promising efficacy results in dermatology and rheumatology prompted the evaluation of these drugs in Crohn's disease and ulcerative colitis, but the onset of paradoxical events (disease exacerbation after treatment with a theoretically curative drug) prevented their approval in patients with inflammatory bowel diseases (IBDs). To date, the pathophysiological mechanisms underlying these paradoxical effects are not well defined, and there are no clear guidelines for the management of patients with disease flare or new IBD onset after anti-IL-17 drug therapy. In this review, we summarise the literature on putative mechanisms, the clinical digestive effects after therapy with IL-17 inhibitors and provide guidance for the management of these paradoxical effects in clinical practice.

Paradoxical gastrointestinal effects of interleukin-17 blockers