A90 THREE PATIENTS WITH INFLAMMATORY BOWEL DISEASE DIAGNOSED WHILE BEING TREATED WITH SECUKINUMAB FOR PSORIASIS

Abstract

Aims: We report three cases of inflammatory bowel disease (IBD) in patients on secukinumab, an anti-IL-17A antibody, for psoriasis. Method(s): Case Review Results: Patient one: 49 year old female, with a history of psoriasis managed with secukinumab, presented to hospital with a six-day history of bloody diarrhea. C-reactive protein was >190 mg/L and erythrocyte sedimentation rate was 70 mm/hr. Colonoscopy showed severe colitis. Pathology showed cryptitis, crypt abscesses, crypt architectural irregularity, without granulomatous lesions. She was started on intravenous steroids during her hospitalization and on infliximab for maintenance IBD therapy. Her secukinumab was discontinued. Patient two: 54 year old male with psoriasis that was managed with secukinumab. The patient developed symptoms of diarrhea, occurring 6-7 times per day, shortly after secukinumab exposure. Colonoscopy showed severe pancolitis. Histology showed patchy chronic inflammation, consistent with IBD. He was started on adalimumab and methotrexate therapy, and achieved clinical remission. Secukinumab was discontinued. Patient three: 28 year old male on secukinumab therapy for his psoriasis with good clinical response. Shortly after starting secukinumab he developed diarrhea symptoms, having 3-4 loose bowel movements per day. Fecal calprotectin was elevated at 563.8 mg/kg. Colonoscopy and histology showed colonic mucosa with focal active cryptitis and non-necrotizing granulomas. Secukinumab was discontinued and he was started on ustekinumab for his psoriasis, with clinical response. Conclusion(s): The role of secukinumab in Crohn's disease has been investigated in a randomised double-blind placebo-controlled trial, which showed IL-17A blockade was not effective in the treatment of Crohn's disease and resulted in more adverse events when compared to placebo (Hueber et al). In this study, six severe drug-related adverse events were reported in the secukinumab group and one such event in the placebo group; five of these events were worsening of Crohn's disease. The current evidence suggests that IL-17A blockade is efficacious in psoriasis. A pooled analysis of ten phase II and III studies in patients with plaque psoriasis showed an overall favorable safety profile. In this analysis, three cases of Crohn's disease were reported among individuals on secukinumab (Malakouti et al). Our cases of inflammatory bowel disease diagnosed in three patients on secukinumab for psoriasis highlight the complex and multifaceted role of the Th17 pathway. The Th17 inflammatory response can be either protective or exacerbating depending on the organ system involved.