Inflammatory bowel disease and multiple sclerosis

Introduction

Inflammatory bowel disease (IBD), which mainly includes Crohn’s disease and ulcerative colitis, is characterised by chronic inflammation in the gastrointestinal tract, triggered and perpetuated by an altered immune response. An association has been established between this condition and other autoimmune diseases, including multiple sclerosis (MS). The prevalence of MS in patients with IBD is 0.2%; the association between the 2 conditions is attributed to shared genetic and environmental pathogenic mechanisms.

Development

In patients presenting with both diseases, several considerations should be taken into account when selecting the most appropriate treatment. Regarding MS treatment, interferons have been associated with worsening of IBD symptoms, whereas such monoclonal antibodies as rituximab and ocrelizumab may cause gastrointestinal toxicity, and alemtuzumab is not recommended due to increased risk of autoimmune complications. Natalizumab and sphingosine 1-phosphate modulators, such as ozanimod, constitute safer and more effective options for patients with IBD.

Regarding treatments for IBD, TNF-α antagonists are contraindicated in patients with MS due to the associated risk of central nervous system demyelination. Vedolizumab and ustekinumab are the recommended alternatives in these cases.

Conclusions

Though weak, the association between IBD and MS should be acknowledged; preferably, management of these patients should include medications that treat both conditions simultaneously.