Secukinumab as a potential trigger of inflammatory bowel disease in ankylosing spondylitis or psoriatic arthritis patients

Abstract

Objectives Real-world secukinumab gastrointestinal related adverse events (GIRAE) data as treatment for ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are lacking. We aimed to achieve this through baseline evaluation of pre-existing inflammatory bowel disease (IBD), rates and predictors of GIRAE. Methods Patient electronic and paper records commencing secukinumab from ten UK hospitals between 2016–2019 were reviewed. GIRAE after initiation were defined as: definite (objective evidence of IBD (biopsy proven), clear temporal association, resolution of symptoms on drug withdrawal, no alternative explanation felt more likely), probable (as per definite, but without biopsy confirmation) or possible (gastrointestinal symptoms not fulfilling definite or probable criteria). Results Data for all 306 patients started on secukinumab were analysed: 124 (40.5%) AS and 182 (59.5%) PsA. 24/306 (7.8%) experienced GIRAE after starting secukinumab. Amongst patients who developed GIRAE, 4 (1.3%) had definite, 7 (2.3%) probable and 13 (4.2%) possible IBD. All definite cases were patients with AS and stopped secukinumab; two had pre-existing IBD and two (0.7%) were de-novo cases of which one required surgical intervention. Seven patients (2.3%) had pre-existing diagnoses of IBD prior to initiation of which 5 patients experienced GIRAE. Conclusion Absolute rates of new IBD in patients starting secukinumab are low. The majority of patients developing new GIRAE did not develop objective evidence of IBD or stop therapy. For patients with pre-existing IBD and AS the risk of GIRAE is much higher, and prescribing alternatives should be considered.

New‐onset Crohn's disease after interleukin‐17A inhibitor therapy with secukinumab: A report of an unusual case

“…In spite of the increased incidence rate of IBDs, including ulcerative colitis (UC) and CD, in the past two decades in Taiwan, the crude incidence of CD remains low at 0.47 in 100 000 population in 2015 3–6 . On the basis of the medical history and development of gastrointestinal manifestation after secukinumab therapy, IL‐17A inhibitor therapy‐induced CD was diagnosed in the present case 7 . To our knowledge, this is the first reported case of IL‐17A inhibitor therapy‐induced CD in Taiwan 8 …”

“…[3][4][5][6] On the basis of the medical history and development of gastrointestinal manifestation after secukinumab therapy, IL-17A inhibitor therapy-induced CD was diagnosed in the present case. 7 To our knowledge, this is the first reported case of IL-17A inhibitor therapy-induced CD in Taiwan. 8 Most inflammatory cytokine inhibitors such as IL-6, IL-1, IL-17, and IL-23 are effective against chronic systemic inflammatory diseases.…”

Evidence for the Use of Secukinumab in Patients with Radiographic and Non-radiographic Axial Spondyloarthritis in the Last 5 Years

“…Evidence with secukinumab has shown that the incidence of new-onset IBD is low in patients with axSpA, although these patients are more likely to develop IBD than the general population [ 73 , 74 ]. A pooled analysis of data from secukinumab randomized controlled trials showed that 13/794 patients with AS developed IBD, including ulcerative colitis in four patients (EAIR 0.2 per 100 patient-years), Crohn’s disease in eight (EAIR 0.4) and IBD undefined in one (EAIR 0.1) [ 73 ].…”

“…Notably, the risk of IBD development during secukinumab treatment does not increase over time [ 73 ]. Real-world data suggest that the risk of IBD development during secukinumab is higher in AS patients with a history of IBD than in those without such a history [ 74 ].…”

Genetic screening in new onset inflammatory bowel disease during anti-interleukin 17 therapy: unmet needs and call for action

“…They observed that amongst patients who developed gastrointestinal adverse events 4 had definite IBD, 7 had probable IBD while 13 had possible IBD and that all definite IBD cases had concomitant ankylosing spondylitis. Of these, two had preexisting IBD and the other two were de-novo cases, with one requiring surgical care [9].…”