The following article is a part of conference coverage from the 2019 Advances in Inflammatory Bowel Diseases (AIBD) Meeting, being held in Orlando, Florida. The team at MPR will be reporting on the latest news and research conducted by leading experts gastroenterology. Check back for more from the 2019 AIBD Meeting.
A recently published report presented at the 2019 AIBD Annual Meeting in Orlando, FL, discussed the case of a patient who developed ulcerative colitis (UC) following treatment with Secukinumab for her psoriatic arthritis and highlighted a novel approach for the management of both of her conditions simultaneously.
The patient, a 52-year-old female with a long history of psoriatic arthritis, presented complaining of bloody diarrhea over the past month. Stool studies and biopsies as well as a CT Scan of Abdomen and Pelvis were performed and revealed normal results. A colonoscopy, however, revealed that the patient had ulcerative colitis (UC) extending from the hepatic flexure to rectum. “Biopsies showed crypt abscesses consistent with inflammatory bowel disease (IBD) alone with a positive serum p-ANCA,” the authors explained. The patient stated that she had no history of UC or IBD but did note that her psoriatic arthritis had been unsuccessfully treated with Etanercept, Leflunomide, Adalimumab, and Methotrexate in the past.
The patient’s Secukinumab was discontinued and she was initiated on prednisone 40mg daily and mesalamine 4.8g daily. The patient improved and was, therefore, discharged. To allow for a prednisone taper, she was later initiated on Tofacitinib 10mg twice daily for treatment of both psoriatic arthritis and UC. In addition to complete resolution of her bloody diarrhea, objective improvement of the patient’s psoriatic arthritis was also observed.
In their discussion, the authors stated that, although there have been case reports of Secukinumab-induced UC published in the past, treatment typically involves infliximab, a monoclonal TNF-alpha antibody, if steroids initially fail. For this patient, however, optimizing immunologic therapy was difficult since she was resistant to multiple forms of THF-alpha inhibition with Adalimumab and Etanercept. Because of this, a novel approach of initial steroid therapy followed by treatment with Tofacitinib provided excellent resolution of the patient’s symptoms and conditions.
“Nonetheless, psoriatic arthritis cases on Secukinumab who develop ulcerative colitis and have failed prior TNF-alpha antibody treatment merit this novel approach to therapy with Tofacitinib,” the authors concluded. They added, “We might consider Tofacitinib even in cases who have not failed prior TNF-alpha antibody treatment given greater acceptance by patients of oral medical therapy.”
Sethi V, Jacobs A, Sethi A. Secukinumab induced ulcerative colitis in a patient with psoriatic arthritis: A novel approach to refractory cases. Presented at: 2019 AIBD Annual Meeting; December 12-14 in Orlando, FL.