Patients with moderate-to-severe plaque psoriasis who also have concomitant inflammatory bowel disease (IBD) present a distinct clinical challenge. Therapy selection must address both conditions simultaneously, and certain systemic agents suitable for psoriasis alone carry meaningful risk in this population.
This protocol applies to adults with moderate-to-severe plaque psoriasis and a concomitant diagnosis of inflammatory bowel disease. Patients with a history of concomitant IBD might benefit from TNF-α inhibitor therapy that targets both conditions. The presence of IBD narrows the biologic options that can be safely employed.
The recommended strategy is to initiate a biologic that is approved for inflammatory bowel disease. A specific class of biologic commonly used in psoriasis alone is explicitly avoided in this setting due to risk in IBD patients. The full structured regimen — including which agents are appropriate, the sequencing, and all relevant clinical guidance — is available via the link below.
Full regimen details, dosing, and algorithm not shown here → see protocolThe primary clinical target is a 75% improvement in the Psoriasis Area Severity Index (PASI 75).
DOI: 10.1016/j.jaad.2018.11.057
Patients with a history of concomitant inflammatory bowel disease (IBD) might benefit from TNF-α inhibitor therapy.
In fact, adalimumab, infliximab, and certolizumab are approved for the treatment of IBD.
Ustekinumab is FDA-approved for the treatment of Crohn's disease.
Although the number of patients presenting with this adverse effect in clinical trials was relatively small, it is recommended that the use of IL-17 inhibitors be avoided in patients with a personal history of or active IBD.
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