Canadian IBD Today

Is IL-23 the Winner? Lessons from Inflammatory Bowel Disease (IBD) and Psoriasis (PsO)

Jesse Siffledeen — 2025-12-22

Key Takeaways

• Interleukin-23 (IL-23), and the IL-23/Th-17 interaction, plays a pivotal role in the pathogenesis of immune‑mediated diseases, such as psoriasis (PsO) and inflammatory bowel disease (IBD). This has led to the development and commercialization of several anti-IL-23 therapies, all demonstrating high efficacy and safety in the management of these conditions.

• Anti-IL-23 therapies, have been shown to be amongst the most highly effective treatments in PsO, achieving meaningful and durable treatment response (PASI-90) in over 80 per cent of participants in registrational clinical trials, while in IBD the meaningful one-year efficacy, based on the varied definitions of the studies’ primary endpoints, is achieved (at most) in just over 50 per cent of participants, though rates of achieving remission in Crohn’s disease are much lower.

• Several ongoing studies examining the role of IL-23 inhibition in specific IBD populations (ex. perianal Crohn’s disease), and studies examining the combination of IL-23 inhibitors with other targeted therapies, capitalizes on the excellent safety and efficacy profile of anti-IL-23, reflecting the long-term importance of these therapies in the IBD treatment landscape.

Pregnancy in Inflammatory Bowel Disease (IBD)

Vivian W. Huang — 2025-12-22

Key Takeaways

• Preconception assessment and counselling is recommended for women with IBD who are contemplating pregnancy, ideally occurring at least 3 to 6 months prior to attempts at conception

• Most IBD therapies are recommended to be continued throughout pregnancy and lactation to minimize the potential detrimental impact of active disease on infant and maternal outcomes

• Consideration of aspirin commencement for preterm preeclampsia prevention is recommended, prior to 16 weeks gestation, in women with IBD, especially if additional risks for preeclampsia development

• Infants exposed to biologics in utero can receive inactive vaccines and Rotavirus live vaccine per schedule.

Artificial Intelligence in Inflammatory Bowel Disease (IBD) Diagnostics: Applications and Future Directions

Amine Zoughlami — 2025-12-22

Key Takeaways

• AI can improve the accuracy, objectivity, and reproducibility of IBD disease assessments across multiple disease assessment indices.

• Multiple AI models have shown expert-level performance in the assessment of endoscopic and histologic activity in IBD.

• The deployment of AI models can help uniformize the quality of disease assessment across academic and community centres alike.

• The next steps will involve multimodal AI models. The development of these models, and the fine-tuning of unimodal systems, will require large, diverse datasets and careful governance.

Inflammatory Joint Pain in Inflammatory Bowel Disease (IBD) Patients Treated with Anti‑Tumour Necrosis Factor (TNF) Therapy: Differentiating IBD Arthritis, Paradoxical Arthritis, Anti‑TNF‑induced Lupus, and Serum-Sickness-Like Reactions

Vivek Govardhanam — 2025-12-22

Key Takeaways

• We propose a mechanism based approach assessing bowel activity, timing of drug exposure and auto-antibody profile to manage arthritis in IBD patients treated with anti-TNF therapy.

• Paradoxical arthritis, anti-TNF- induced lupus, and serum-sickness-like reaction can occur with anti-TNF therapy; all require a change in targeted therapy.

• Managing arthritis in IBD requires multidisciplinary work between gastroenterologist and rheumatologist to optimize treatment of both manifestations.