What medications are effective for both psoriasis and inflammatory bowel disease?

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Last updated: February 15, 2026 • View editorial policy

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Medications Effective for Both Psoriasis and IBD

TNF inhibitors—specifically infliximab and adalimumab—are the preferred first-line biologic therapies for patients with both psoriasis and inflammatory bowel disease, as they have demonstrated efficacy in treating both conditions simultaneously. 1, 2, 3

Primary Treatment Options

TNF Inhibitors (First-Line)

  • Infliximab is FDA-approved and effective for psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease, making it an excellent choice when treating both conditions concurrently 1, 3
  • Adalimumab similarly demonstrates efficacy across all four indications (psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease) 1, 3
  • Both agents work by targeting shared inflammatory pathways (TNF-alpha) that drive disease activity in both psoriasis and IBD 4
  • Biosimilars of infliximab and adalimumab are supported due to equivalent effectiveness and safety at reduced costs 2

Alternative TNF Inhibitors

  • Certolizumab pegol is effective for psoriatic arthritis and Crohn's disease (but not ulcerative colitis) 2, 3
  • Golimumab is specifically recommended for ulcerative colitis with axial spondyloarthritis 2

Second-Line Options

IL-12/23 Inhibitor

  • Ustekinumab is an excellent alternative that is FDA-approved for both Crohn's disease and psoriasis, with demonstrated effectiveness in phase 3 trials for IBD, including in patients who failed TNF inhibitors 1, 3
  • Ustekinumab has shown efficacy in psoriasis, psoriatic arthritis, and Crohn's disease 3
  • This agent can be considered when TNF inhibitors are not suitable or have failed 1

JAK Inhibitors (After TNF Failure)

  • Tofacitinib and upadacitinib are FDA-approved for moderate-to-severe ulcerative colitis and should be reserved as second-line therapy after TNF inhibitor failure 1, 2

Critical Medications to AVOID

IL-17 Inhibitors (Absolute Contraindication)

  • Secukinumab, ixekizumab, and brodalumab must be strictly avoided in patients with IBD or at risk for IBD, as they can cause new-onset inflammatory bowel disease or exacerbate existing disease 1, 5, 6
  • The American Academy of Dermatology explicitly recommends avoiding IL-17 inhibitors in IBD patients (Strength of Recommendation C, Level of Evidence I) 1
  • Clinical trials have demonstrated that IL-17 inhibitors can exacerbate Crohn's disease 1, 3
  • These agents (etanercept, secukinumab, brodalumab, ixekizumab) have efficacy in psoriasis and psoriatic arthritis but may induce or worsen IBD 3

Etanercept

  • Etanercept should not be used due to its ineffectiveness in active Crohn's disease and potential to trigger new-onset Crohn's disease 2

Vedolizumab

  • Vedolizumab is not recommended for IBD with psoriasis because it lacks efficacy for dermatologic manifestations despite being effective for IBD 2

Combination Therapy Considerations

  • TNF inhibitors combined with thiopurines or methotrexate show superior efficacy for ulcerative colitis remission compared to monotherapy, and this combination approach can benefit both the UC and psoriasis components 1
  • Methotrexate has demonstrated efficacy for both psoriasis and IBD and may be used in combination with biologic agents 1

Essential Screening and Monitoring

Pre-Treatment Screening

  • Screen all psoriasis patients for IBD symptoms before starting systemic therapy, as the prevalence of ulcerative colitis is 1.64-1.91 times higher and Crohn's disease is 2.49 times higher in psoriasis patients versus controls 1
  • Red-flag symptoms requiring immediate gastroenterology referral include: chronic diarrhea lasting ≥3 months, nocturnal bowel movements, rectal bleeding not from hemorrhoids, persistent abdominal pain, perianal fistula/abscess, and unintentional weight loss 1

During Treatment Monitoring

  • Monitor for new or worsening gastrointestinal symptoms during psoriasis treatment, warranting immediate gastroenterology referral (Strength of Recommendation A) 1
  • Patients with psoriatic arthritis, especially those with axial involvement, exhibit higher incidence and prevalence of IBD than patients with skin-only psoriasis 1

Common Pitfalls to Avoid

  • Never prescribe IL-17 inhibitors to patients with known IBD or suspicious gastrointestinal symptoms—this is the most critical error to avoid 1, 5, 6
  • Do not assume that all biologics effective for psoriasis will be safe for IBD—the IL-17 pathway demonstrates this critical distinction 4, 5
  • If paradoxical psoriasiform eruptions develop while on TNF inhibitor therapy for UC, first attempt to add standard psoriasis treatments (topical corticosteroids, vitamin D analogues) while continuing the TNF inhibitor, as this achieves complete or partial skin clearance in 90% of cases 1

References

1
Guideline

Treatment of Ulcerative Colitis and Psoriasis

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Best Biologic Therapy for IBD with Diffuse Arthropathy

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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