Biologic Switching — SCE Dermatology MCQ

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ModerateDermatopharmacologyBiologic SwitchingSCE Dermatology

A 40-year-old man with psoriasis is on Secukinumab. He develops new-onset Crohn disease symptoms (abdominal pain, bloody diarrhoea, weight loss). Colonoscopy confirms Crohn disease. What biologic switch is most appropriate?

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Correct answer: A — Switch to Adalimumab or Ustekinumab (both approved for psoriasis AND Crohn disease)

This confirms the well-documented risk of IL-17 inhibitor-triggered IBD. Secukinumab must be stopped. The biologic switch should address BOTH conditions: Adalimumab and Infliximab (anti-TNF) are approved for both psoriasis and Crohn disease. Ustekinumab (anti-IL-12/23) is also approved for both conditions. Risankizumab (selective anti-IL-23 p19) now has approvals for both psoriasis and Crohn disease, making it another excellent option. Switching to another IL-17 inhibitor (Ixekizumab, Brodalumab) is contraindicated as the class effect on IBD applies to all IL-17 pathway agents. Multidisciplinary management with gastroenterology is essential.

Reference: BAD 2020 Biologic Guidelines; NICE IBD/Psoriasis