Ankylosing spondylitis patients receiving secukinumab should be monitored and switched to other options if they begin to develop digestive symptoms, a study suggests.
Secukinumab (trade name Cosentyx) is a human anti-interleukin-17 monoclonal antibody that inhibits interleukin 17A, a molecule produced mainly by inflammatory cells of the immune system that promotes inflammation.
The U.S. Food and Drug Administration approved secukinumab to treat adults with moderate-to-severe plaque psoriasis in 2015, and ankylosing spondylitis and psoriatic arthritis in 2016.
Despite being currently used in the treatment of chronic autoimmune conditions, secukinumab’s fact sheet states that it should be used cautiously in patients with inflammatory bowel disease (IBD).
IBD has been linked to these conditions, making this issue of clinical importance. Furthermore, because secukinumab was approved in 2015, only limited data exist regarding the long-term effects of its use. No reports regarding IBD development during treatment previously had been published.
The study “Emergence of Inflammatory Bowel Disease During Treatment With Secukinumab,” published in the Journal of Crohn’s and Colitis, describes two cases of patients who developed IBD during treatment with secukinumab.
One was a 60-year-old man who had been diagnosed with ankylosing spondylitis. The patient was initially treated with naproxen, which showed poor disease control. Sulfasalazine, tramadol, and subcutaneous secukinumab (150 mg every four weeks) were added to his treatment regimen. However, the patient developed diarrhea, rectal bleeding, and abdominal pain, and the medication was stopped. He was subsequently treated with steroids, mesalazine (used to treat ulcerative colitis and Crohn’s disease), and infliximab (used to treat several chronic inflammatory diseases).
The symptoms stopped after the second dose of infliximab.
Another patient, a 19-year-old woman, had been diagnosed with generalized plaque psoriasis. She was initially treated with methotrexate, which was stopped after treatment intolerance and recurrence of skin lesions.
She was then treated with secukinumab (subcutaneously delivered at 300 mg every four weeks). Two months into the treatment, the patient experienced nausea, soft stool, and abdominal pain. After a series of laboratory tests were conducted, including for infections, doctors determined that the patient experienced inflammatory changes similar to those seen in Crohn’s disease.
After treatment with corticosteroids, the symptoms eased and the patient was subsequently treated with ustekinumab instead of secukinumab.
The researchers concluded that “in addition to the warning against the use of secukinumab in IBD, in view of the two clinical cases detected, the need for … close monitoring of possible digestive manifestations should be considered in all patients treated with this drug. Ustekinumab, infliximab or adalimumab would be safer therapeutic options in these cases.”