Inflammatory Bowel Disease therapies and Demyelinating Diseases: A Practical Guide to Therapeutic Benefit and Risk.

Fiche publication

Date publication

novembre 2025

Journal

Journal of Crohn's & colitis

Auteurs

Membres identifiés du Cancéropôle Est :
Pr PEYRIN-BIROULET Laurent

Tous les auteurs :
Honap S, Debouverie M, Filippi M, Selchen D, Jairath V, Danese S, Peyrin-Biroulet L

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/41317369

Résumé

Demyelinating diseases, particularly multiple sclerosis (MS), present a unique therapeutic challenge in the management of inflammatory bowel disease (IBD). Although rare, the co-occurrence of IBD and demyelinating disorders is well-documented and may reflect shared immune, genetic, and environmental risk factors. As the therapeutic landscape of IBD expands to include biologics and small molecules that target immune pathways also implicated in MS, concerns around neurological safety have grown. In particular, anti-tumour necrosis factor agents have been consistently linked to new-onset or worsening demyelinating events, while other treatments such as sphingosine-1-phosphate receptor modulators and natalizumab are licensed for both IBD and MS, though real-world data in patients with coexisting disease remain limited. This review synthesises current evidence regarding the neurological safety and efficacy of IBD therapies in the context of demyelinating disease. It proposes a practical framework for clinicians, addressing management strategies for patients with confirmed MS, those at increased risk, and individuals who develop neurological symptoms during treatment. In the absence of formal guidelines, multidisciplinary collaboration, early recognition of symptoms, and careful treatment selection are important to optimise both gastrointestinal and neurological outcomes.