scholarly journals A194 A POSSIBLE ASSOCIATION BETWEEN SECUKINUMAB AND NEW-ONSET INFLAMMATORY BOWEL DISEASE: A CASE SERIES

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 216-217
Author(s):  
A Sarker ◽  
T Shukla ◽  
A Rostom ◽  
J Sim ◽  
J D McCurdy
Keyword(s):  
Inflammatory Bowel Disease ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Autoimmune Diseases ◽  
Bowel Disease ◽  
Intestinal Inflammation ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Inflammatory Bowel ◽  
New Onset

Abstract Background Secukinumab is a monoclonal antibody targeting interleukin-17A and is commonly used for managing autoimmune diseases such as, psoriasis, psoriatic arthritis, and ankylosing spondylitis. Prior studies have suggested that anti-IL17 therapy may worsen symptoms in patients with pre-existing inflammatory bowel disease (IBD). However, it remains unclear if secukinumab is associated with new-onset IBD or in provoking a flare of previously quiescent IBD. Aims We evaluated patients referred to our IBD clinic who developed intestinal inflammation after starting secukinumab for the management of autoimmune diseases. Methods We performed a retrospective, observational study at a single tertiary care center between 2017 and 2020. Patients referred to our IBD clinic who developed intestinal inflammation after starting secukinumab were included. We excluded patients with an established pre-existing diagnosis of IBD and patients who had positive stool testing for infectious organisms. Patient demographics, disease characteristics, distribution of intestinal inflammation and clinical outcomes were assessed. The pathology slides were reinterpreted by a single pathologist with a specialty in gastroenterology to determine the histologic characteristics of the inflammation. Results A total of 8 patients developed gastrointestinal symptoms after starting secukinumab: 4 (50%) males with a median age of 42.5 (IQR: 35–50 years old). Secukinumab was initiated for psoriasis in 3 (37.5%) patients, psoriatic arthritis in 2 (25%) patients, ankylosing spondylitis in 2 (25%) patients and juvenile idiopathic arthritis in 1 (12.5%) patient. The median time of onset for gastrointestinal symptoms after starting secukinumab was 7 months (IQR: 4–15 months). Of the patients who underwent testing for inflammatory biomarkers, the median CRP was 25.5 (IQR 25.4–34.2). Endoscopic disease distribution involved the colon in 5 (62.5%) patients and the ileum and colon in 3 (37.5%) patients. In this series of patients, the histologic characteristics demonstrated three patterns of colitis: IBD-like (ulcerative colitis or Crohn’s disease) in 6 (75%) patients based on mucosal granulomas and/or chronic inflammatory changes, MMF-like histology in 1 (12.5%) patient, characterized by an abundance of intraepithelial eosinophils in the lamina propria and numerous crypt apoptotic bodies, and finally active colitis in 1 (12.5%) patient characterized by an absence of chronic mucosal injury or granulomas. The treatment for these patients was cessation of secukinumab and initiating alternative therapies with close clinical monitoring. Conclusions In this small case series, Secukinumab was temporally associated with the development of gastrointestinal inflammation. Further larger studies are required to confirm this association and to determine if IL-17 contributes to the pathogenesis of IBD. Funding Agencies None

scholarly journals Incidence rates of inflammatory bowel disease in patients with psoriasis, psoriatic arthritis and ankylosing spondylitis treated with secukinumab: a retrospective analysis of pooled data from 21 clinical trials

2019 ◽  
Vol 78 (4) ◽  
pp. 473-479 ◽  
Author(s):  
Stefan Schreiber ◽  
Jean-Frederic Colombel ◽  
Brian G Feagan ◽  
Kristian Reich ◽  
Atul A Deodhar ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clinical Trials ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Bowel Disease ◽  
Pooled Analysis ◽  
Incidence Rates ◽  
Inflammatory Bowel ◽  
Adjusted Incidence ◽  
New Onset

ObjectivesHere, we present the reported incidence rates of inflammatory bowel disease (IBD) in patients receiving treatment with secukinumab for psoriasis (PsO), psoriatic arthritis (PsA) or ankylosing spondylitis (AS), in a pooled analysis of 21 clinical trials.MethodsData from all patients who had received at least one dose of secukinumab were included. Safety analyses were conducted to evaluate cumulative IBD rates as well as per-year rates, by indication. Crohn’s disease (CD), ulcerative colitis (UC) and IBD unclassified (IBDU) events were analysed using exposure-adjusted incidence rates (patient incidence rates per 100 patient-years (PY)).ResultsA total of 7355 patients with a cumulative exposure of 16 226.9 PY were included in the pooled analysis. Among 5181 patients with PsO, there were 14 cases of UC, 5 cases of CD and 1 case of IBDU, with exposure adjusted incidence rates (EAIRs) of 0.13, 0.05 and 0.01, respectively. Of these 20 cases, 14 were new-onset. In 1380 patients with PsA, there were 3 cases of UC, 3 cases of CD and 2 cases of IBDU (EAIRs 0.08, 0.08 and 0.05); 7 of these represented new-onset cases. Among 794 patients with AS, there were 4 cases of UC, 8 cases of CD and 1 case of IBDU (EAIRs 0.2, 0.4 and 0.1); 9 were new-onset cases. In the per year analysis, the EAIRs for each indication did not increase over time with secukinumab treatment.ConclusionsIn this pooled secukinumab safety analysis of 7355 patients across 21 clinical trials, cases of IBD events (including CD, UC and IBDU) were uncommon.

scholarly journals Asymptomatic Crohn’s disease identified in a patient being treated with secukinumab: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1989358
Author(s):  
Wasim Haidari ◽  
Sarah Al-Naqshabandi ◽  
Christine S Ahn ◽  
Richard S Bloomfeld ◽  
Steven R Feldman
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Gastrointestinal Symptoms ◽  
Good Choice ◽  
History Of ◽  
Inflammatory Bowel ◽  
Multiple Ulcers ◽  
New Onset

IL-17 antagonism is among the most potent treatments for psoriasis. Generally safe, new onset and exacerbations of inflammatory bowel disease may occur in association with IL-17 therapy. We describe a patient with long-standing history of psoriasis and psoriatic arthritis in whom asymptomatic Crohn’s disease was identified during treatment with secukinumab. The patient underwent an elective colonoscopy for colorectal cancer screening which revealed inflammation and multiple ulcers in the terminal ileum suggestive of Crohn’s disease. While the patient did not have any gastrointestinal symptoms, he was diagnosed as having asymptomatic Crohn’s disease. Given the association of inflammatory bowel disease with secukinumab treatment, secukinumab was discontinued. Although in this patient, Crohn’s disease was identified during treatment with secukinumab, a direct causal relationship cannot be assumed. Medications that are effective for both psoriasis and inflammatory bowel disease may be a good choice in patients with psoriasis who have comorbid Crohn’s disease or develop inflammatory bowel disease during treatment with another biologic.

scholarly journals A Rare Form of Chronic Granulomatous Disease (Type Iva) Presenting as Inflammatory Bowel Disease

1996 ◽  
Vol 10 (4) ◽  
pp. 221-224 ◽  
Author(s):  
Francisco A Sylvester
Keyword(s):  
Inflammatory Bowel Disease ◽  
Chronic Granulomatous Disease ◽  
Bowel Disease ◽  
Intestinal Inflammation ◽  
Gastrointestinal Symptoms ◽  
Hypochromic Anemia ◽  
Granulomatous Disease ◽  
Poor Growth ◽  
Inflammatory Bowel ◽  
Chronic Intestinal Inflammation

Neutrophil dysfunction syndromes can sometimes mimic the clinical and pathological features of inflammatory bowel disease. The case of a 3.5-year-old boy with chronic diarrhea, abdominal pain, poor growth since infancy and microcytic, hypochromic anemia is presented. After an extensive diagnostic evaluation, he was found to have a rare variant (type IVA) of chronic granulomatous disease. His gastrointestinal symptoms markedly improved during therapy with gamma-interferon. Chronic granulomatous disease can present initially with a clinical picture suggestive of chronic intestinal inflammation. Therefore it should be considered in the differential diagnosis of atypical inflammatory bowel disease, both in children and young adults.

Antitumor Necrosis Factor-α Therapy Associated with Inflammatory Bowel Disease: Three Cases and a Systematic Literature Review

2017 ◽  
Vol 44 (7) ◽  
pp. 1088-1095 ◽  
Author(s):  
Amir Bieber ◽  
Abdallah Fawaz ◽  
Irina Novofastovski ◽  
Reuven Mader
Keyword(s):  
Inflammatory Bowel Disease ◽  
Literature Review ◽  
Bowel Disease ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Patient Specific ◽  
Tnf Α ◽  
Inflammatory Bowel ◽  
Factor Α ◽  
Necrosis Factor

Objective.Antitumor necrosis factor-α (anti-TNF-α) therapy is the most prescribed biologic agent therapy in rheumatology and gastroenterology. However, a number of serious side effects have been reported with these drugs. Only a handful of cases of new-onset inflammatory bowel disease (IBD), mostly in children diagnosed with juvenile idiopathic arthritis (JIA), have been reported during anti-TNF-α therapy. We present 3 cases of adult IBD following anti-TNF-α therapy and a literature review on this topic.Methods.We searched PubMed MESH for all relevant terms, papers were reviewed, and patient-specific data were extracted. Relevant clinical data were calculated and presented.Results.The PubMed search resulted in 137 articles, of which 11 articles and 4 cited publications were included in our analysis. We found 53 cases of IBD after anti-TNF-α therapy reported in the literature; most of them were case series collected retrospectively from national databases or studies. Almost all the patients developed IBD after the introduction of etanercept (ETN); 2 patients with rheumatoid arthritis were also included. The average age at IBD onset was 17.3 years and the average time from ETN introduction to IBD onset was 27 months (± 24). Gastrointestinal symptoms have been reported as improving or subsiding in most of the patients after discontinuing ETN.Conclusion.Although this manifestation is not common, it should be taken into consideration as an adverse effect of ETN. Rheumatologists, and in particular rheumatologists treating adult patients, should be aware of this possible complication. Further investigation about the pathogenic process underlying this phenomenon is warranted.

scholarly journals Undifferentiated seronegative spondyloarthritis with inflammatory bowel disease and a family history of psoriasis. Sicca syndrome

2013 ◽  
pp. 189-191
Author(s):  
Norma Marigliano ◽  
Domenico Galasso
Keyword(s):  
Inflammatory Bowel Disease ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Bowel Disease ◽  
Acute Inflammation ◽  
Clinical Manifestations ◽  
Hla B27 ◽  
History Of ◽  
Seronegative Spondyloarthritis ◽  
Inflammatory Bowel

Background: Seronegative spondyloarthritis is characterized by the presence of subcutaneous nodules, asymmetrical peripheral arthritis, sacroileitis with or without spondylitis, and rheumatoid-factor negativity. Other common clinical manifestations include oral ulcers, conjunctivitis, and cutaneous lesions such as psoriasis. Familial aggregation has also been described. According to the 1986 classification, corresponding clinical entities include ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome, arthritis associated with inflammatory bowel disease (IBD), and undifferentiated spondyloarthritis. The disease is also frequently associated with the HLA B27 antigen. From the clinical point of view, there are often incomplete forms of spondyloarthritis, such as reactive arthritis triggered by asymptomatic infections, psoriatic arthritis without psoriasis itself, initial phases of specific forms of spondyloarthritis or the phase of ankylosing spondylitis characterized by sacroiliac lesions, and all forms that remain undifferentiated for long periods of time. Moreover, there are close relations between arthropathy and IBDs, such as Crohn’s disease, ulcerative colitis, and Whipple’s syndrome. Recently, microscopic inflammatory bowel lesions and psoriatic arthritis have been described. Case report: A 30-year-old man (HLA B27-negative) who had been vaccinated against TBC and HBV presented with a 6-year history of recurrent episodes of predominantly left-sided sciatica. The pain was worse at night and during rest. He was suffering from bilateral sacroileitis without spondylitis. Three to five times a day, usually after eating, he passed watery feces containing mucous and small amounts of bright red blood. Colonoscopy revealed pancolitis with histological evidence of chronic inflammation interspersed with areas of acute inflammation, edema, hyperemia, and glandular distortion. One year later, the clinical manifestations and histological findings were essentially unchanged: glandular distortions, chronic and acute inflammation of the lamina propria and crypt microabscesses. There were no granulomas and no evidence of uveitis. The inflammatory index was positive; FR, ENA, ANA titers were negative. He began therapy with adalimumab (loading dose 80 mg followed by 40 mg every 15 days) and mesalazine (2.4 g per os), and the clinical manifestations of the disease improved significantly.

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