Secukinumab‐induced paradoxical hidradenitis suppurativa successfully treated with adalimumab

Abstract

Secukinumab-induced paradoxical hidradenitis suppurativa successfully treated with adalimumabDear Editor, A 47-year-old woman presented with a 16-year history of psoriasis (PsO) and recent onset of psoriatic arthritis (PsA).Prior treatments included topical vitamin D analogs, topical and oral corticosteroids, and oral cyclosporine, with the patient experiencing unsatisfactory disease control. At our observation, the patient presented a plaque type PsO (Psoriasis Area Severity Index [PASI] score: 10.5) with sharply demarcated erythematous plaques of the scalp, back, and inframammary areas, and related severe joint symptoms at proximal interphalangeal and metatarsophalangeal joints (subjective pain Visual Analog Scale [pain-VAS] of 80 and Disease Activity Score 28CRP4 [DAS28-CRP4] of 4.89).

Adalimumab Biosimilar-Induced Severe Paradoxical Palmoplantar Pustulosis in a Patient with Psoriasis and Psoriatic Arthritis Successfully Treated with Ixekizumab

“…Paradoxical reactions of the palmoplantar pustular type have also been newly described with all anti-IL-17 drugs (ixekizumab, secukinumab and brodalumab) [12,13], with the authors explaining that the mechanism of PAEs in anti-IL-17 drugs may be due to a paradoxical increase of TNF-a through blockade of IL-17A. In most of the published cases of paradoxical reactions with anti-IL-17 drugs the patients were switched to either anti-IL-12/23 or anti-IL-23 drug, with the exception of one patient who developed hidradenitis suppurativa during secukinumab therapy and was successfully treated with adalimumab [12][13][14]. Our patient showed a fast response to treatment following the switch to ixekizumab from adalimumab, which shows that therapy with an anti-IL-17A drug could be a treatment option for a paradoxical reaction of the palmoplantar pustulosis type during anti-TNF-a therapy for patients with psoriasis even though PAEs have also been described with anti-IL-17 drugs.…”

Paradoxical Hidradenitis Suppurativa during Biologic Therapy, an Emerging Challenge: A Systematic Review

“…Indeed, recent clinical trials with secukinumab have been performed to evaluate its efficacy and safety in moderate to severe HS. Although the use of anti-IL 17 is still off-label in HS, data are growing in the literature regarding their efficacy (particularly for secukinumab, a fully human IgG1 kappa monoclonal antibody targeting IL 17A) [ 5 , 10 , 11 , 17 , 37 ]. With regard to paradoxical HS, few cases have been reported with the use of secukinumab [ 13 , 17 , 18 , 37 ].…”

“…Although the use of anti-IL 17 is still off-label in HS, data are growing in the literature regarding their efficacy (particularly for secukinumab, a fully human IgG1 kappa monoclonal antibody targeting IL 17A) [ 5 , 10 , 11 , 17 , 37 ]. With regard to paradoxical HS, few cases have been reported with the use of secukinumab [ 13 , 17 , 18 , 37 ]. Particularly, Navarro et al reported the case of a patient suffering from severe psoriasis unresponsive to anti-TNF, who developed paradoxical HS lesions after secukinumab treatment [ 17 ].…”

“…Furthermore, secukinumab is being investigated in a phase III trial for HS treatment. Although only a few cases have been reported, anti-IL 17 has been linked to the development of paradoxical HS [ 5 , 10 , 11 , 17 , 18 , 37 , 38 ]. However, as for anti-TNF, the hypotheses to explain paradoxical HS are still scant.…”

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

“…The onset time of those AESI ranged from 3 days 52 to 96 weeks 60 . A total of 24 AESI was identified (Table 1), including adiposity, 14 alopecia areata, 15 acute autoimmune hemolytic anemia, 16 bullous eruption, 17,18,32 crystalline corneal deposition, 19 drug‐associated vasculitis (including leucocytoclastic vasculitis, IgA vasculitis [henoch‐schönlein purpura], and Behcet's disease), 5,20–24,61 eczematous drug eruption, 11,25–31,62 erectile dysfunction, 35 granuloma annulare, 36–38 hidradenitis suppurativa, 39,40 hypertrichosis, 41 IBD (including Crohn disease [CD], ulcerative colitis [UC], and IBD undefined [IBDU]), 9,12,13 interstitial pneumonia, 42,43 drug‐induced lupus erythematosus, 6,45–47 multiple lentigines, 48 perianal dermatophytosis, 51 pompholyx (dyshidrotic eczema), 33,34 pseudolymphoma, 52 pyoderma gangrenosum, 53,54 raynaud's phenomenon, 55 scleroderma, 57 stomatitis (such as lichenoid mucositis, oral lichen planus, and angular cheilitis), 44,49,50,56 uveitis, 58 and vitiligo 59,60 …”