Safety and efficacy of IL-17 inhibitors in patients with comorbid multiple sclerosis/multiple Sclerosis-like syndrome: a systematic review.

IL-17 inhibitors may benefit patients with dermatologic or rheumatic diseases and comorbid multiple sclerosis (MS) or MS-like syndrome, either alone or in combination with MS-specific disease-modifying therapies (DMTs). To assess the safety and efficacy of IL-17 inhibitors in patients receiving these treatments for any indication who also suffer from comorbid MS or MS-like syndrome. We systematically reviewed the literature to identify and analyse cases of patients treated with IL-17 inhibitors who also had MS/MS-like syndrome. We analysed 19 studies with an aggregate number of 42 patients (mean age 45 years; 58% female). The main primary indications for IL-17 inhibitors were axial spondyloarthritis (axSpA; 31%), psoriasis (PsO; 26%) and psoriatic arthritis (PsA; 24%). Approximately 26% of patients developed MS or MS-like syndrome after exposure to tumour necrosis factor (TNF) inhibitors. Secukinumab (SEC) was the most common IL-17 inhibitor, followed by ixekizumab (IXE), while more than one-third of patients concurrently received MS-specific DMTs. Over a median follow-up of 12.5 months, SEC was discontinued in nine patients as follows: four due to failure to control rheumatic/dermatologic disease, three due to neurological relapse, one due to safety concerns over dual biologic agent use and one due to unknown reasons. Limited evidence suggests that SEC and IXE may be safe and effective treatment options in patients with comorbid MS, either as monotherapies or in combination with MS-specific DMTs.