Vedolizumab-associated psoriasis: until where does gut selectivity go?
Tiago Pereira Guedes1, Isabel Pedroto2, Paula Lago1
1Gastroenterology, Centro Hospitalar Universitário do Porto, Portugal.
Revista Espanola De Enfermedades Digestivas
|June 5, 2020
Summary
Psoriasis can paradoxically develop in patients with Inflammatory Bowel Disease (IBD) treated with biologics. This case report details psoriasis triggered by vedolizumab in a Crohn's disease patient, highlighting potential drug-induced dermatological side effects.
Area of Science:
- Gastroenterology and Dermatology
- Immunology
- Chronic Inflammatory Diseases
Background:
- Inflammatory Bowel Disease (IBD) and psoriasis share immunological and genetic links, yet the relationship remains incompletely understood.
- Biologic therapies targeting immune pathways are used for IBD, but can sometimes induce paradoxical conditions.
Observation:
- A Crohn's disease patient developed psoriasis after adalimumab treatment, which resolved upon drug cessation.
- The same patient later experienced a recurrence of psoriatic lesions after initiating vedolizumab therapy.
- Skin lesions improved after vedolizumab discontinuation, suggesting a drug-induced etiology.
Findings:
- This report describes the first known case of vedolizumab triggering psoriasis in a patient with Crohn's disease.
- The patient experienced two distinct instances of biologic-induced psoriasis during IBD treatment.
- The molecular mechanisms underlying biologic-induced psoriasis in IBD patients require further investigation.
Implications:
- Clinicians should be vigilant for paradoxical dermatological conditions, such as psoriasis, in IBD patients undergoing biologic therapy.
- Understanding these adverse events is crucial for optimizing treatment strategies and patient management in IBD.
- Further research into the immunopathogenesis of drug-induced psoriasis in IBD is warranted.
Related Concept Videos
01:29Drugs for Treatment of Ulcerative Colitis in IBD
360
Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
360
01:29Inflammatory Bowel Disease IV: Pharmacological Management
361
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
361
01:17Drugs for Treatment of Diarrhea-Predominant IBS
522
Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
522
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
379
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
379
01:21Drugs for Treatment of Constipation-Predominant IBS
591
Pharmacological therapies for IBS-C are designed to alleviate abdominal discomfort and enhance bowel function. In patients with IBS-C, fiber supplements may help soften stools and decrease straining, but may also lead to increased gas production and bloating. Osmotic laxatives like milk of magnesia are frequently used to soften stools and increase stool frequency in IBS-C patients. In addition, two drugs approved for use in severe IBS-C adult cases are linaclotide (Linzess) and lubiprostone...
591
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
368
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
368