StemCell Therapy

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 ofpsoriatic arthritis, presented complaining of bloody diarrhea over the pastmonth. Stool studies and biopsies as well as a CT Scan of Abdomen and Pelvis wereperformed and revealed normal results. A colonoscopy, however, revealed thatthe patient had ulcerative colitis (UC) extending from the hepatic flexure torectum. Biopsies showed crypt abscesses consistent with inflammatory boweldisease (IBD) alone with a positive serum p-ANCA, the authors explained. Thepatient stated that she had no history of UC or IBD but did note that herpsoriatic arthritis had been unsuccessfully treated with Etanercept,Leflunomide, Adalimumab, and Methotrexate in the past.

The patients Secukinumab was discontinued and she wasinitiated on prednisone 40mg daily and mesalamine 4.8g daily. The patientimproved and was, therefore, discharged. To allow for a prednisone taper, shewas later initiated on Tofacitinib 10mg twice daily for treatment of bothpsoriatic arthritis and UC. In addition to complete resolution of her bloodydiarrhea, objective improvement of the patients psoriatic arthritis was alsoobserved.

In their discussion, the authors stated that, although therehave been case reports of Secukinumab-induced UC published in the past,treatment typically involves infliximab, a monoclonal TNF-alpha antibody, ifsteroids initially fail. For this patient, however, optimizing immunologic therapywas difficult since she was resistant to multiple forms of THF-alpha inhibitionwith Adalimumab and Etanercept. Because of this, a novel approach of initial steroidtherapy followed by treatment with Tofacitinib provided excellent resolution ofthe patients 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.

Reference

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.

See the rest here:
Case Highlights Novel Approach to Treatment of UC, Psoriatic Arthritis - Monthly Prescribing Reference

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