Review of secukinumab‐induced adverse events of special interest and its potential pathogenesis

Abstract

Although secukinumab has demonstrated high efficacy and favorable safety in moderate‐to‐severe psoriasis and psoriatic arthritis, patients developing adverse events of special interest (AESI) were reported increasingly in real‐world practice. A systematic literature search of the PubMed database was conducted to identify clinical studies or case reports on secukinumab‐induced AESI. More than 1077 patients (aged 18–74 years) from 55 studies were reported to have 24 AESI 3 days to 96 weeks after secukinumab treatment. The four most common AESI was inflammatory bowel disease (n > 1000), eczematous drug eruption (n > 30), drug‐associated vasculitis (n = 8), and drug‐induced lupus erythematosus (n = 4). Most of these AESI were only mild to moderately severe and resolved after secukinumab discontinuation without or with symptomatic treatment. Secukinumab has the potential to develop a number of AESI by probably dysregulating the different expression of polar T‐cell axes (Th1, Th2, Th17, Th22, and/or Treg) and driving various cytokines in some patients. Physicians should be aware of these AESI for timely diagnosis and proper treatment.

Effectiveness and safety of secukinumab in Chinese patients with moderate to severe plaque psoriasis in real‐world practice

“…According to a systematic review reported, a total of 92 reports of eczema were identified and the rates of the adverse event were 1.0%–12.1% in 24 studies in patients treated with biologics for chronic plaque psoriasis 24 . Another review showed that 2.6% to 7.6% patients treated with secukinumab were reported to develop eczematous drug eruptions 25 . The mechanism underlying eczematous drug eruptions following biologic therapy is not yet fully understood.…”

“…In our study, 8 out of the 26 patients had a personal or family history of eczema, allergic rhinitis or asthma. Besides, targeting Th1 or Th17 immune response could induce a shift to a Th2‐dominated immune response, therefore resulting in eczema 24,25 . Additionally, the prevention measures like mask‐wearing and handwashing during the COVID‐19 pandemic increased the skin friction and could change the balance of cutaneous bacterial flora.…”

“…24 Another review showed that 2.6% to 7.6% patients treated with secukinumab were reported to develop eczematous drug eruptions. 25 The mechanism underlying eczematous drug eruptions following biologic therapy is not yet fully understood.…”

“…Besides, targeting Th1 or Th17 immune response could induce a shift to a Th2-dominated immune response, therefore resulting in eczema. 24,25 Additionally, the pre- Although the exacerbation of psoriasis after COVID-19 vaccination was reported in many studies, the rates were different across studies. It was 0.4% according to the data from the German Registries PsoBest and CoronaBest.…”

Newly diagnosed seropositive rheumatoid arthritis in a 52-year-old man superimposed on long-standing ankylosing spondylitis during secukinumab treatment

“…Cases of secukinumab-induced scleroderma, pustular psoriasis, and sarcoidosis have also been reported [ 14 - 16 ]. Secukinumab has the potential to develop several AESI by dysregulation of different expression of the polarity of T cells (Th1, Th2, Th17, Th22, and/or Treg) and reshaping the profile of cytokines in some patients [ 13 ]. It is widely accepted that cytokine blockade with bDMARDs can result in a variety of immune-mediated adverse effects including new onset or exacerbation of psoriasis despite its broad utilization in psoriasis treatment [ 17 ].…”