Secukinumab
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Paradoxical reaction in the form of uveitis: case report A 47-year-old man developed a paradoxical reaction in the form of uveitis during treatment with secukinumab for ankylosing spondylitis (AS). The man was diagnosed with AS 25 years earlier. Initially, he received methotrexate for 1 year, without significant improvement in his symptoms. Due to the persistence of pain and lack of efficacy of methotrexate, he was switched to adalimumab. He subsequently exhibited significant improvement. Two years later, adalimumab was discontinued, and he started receiving etoricoxib alternating with celecoxib and diclofenac, with minimal improvement. Therefore, adalimumab was resumed after 6 months in view of an active disease. He had considerable improvement and he remained on adalimumab. Despite being on adalimumab, he had a flare of his disease in 2011 and he was switched to etanercept. During this time, he developed recurrent infections in the form of skin abscesses and recurrent sinusitis. Therefore, his therapy was withheld until his infections were cured and then etanercept was resumed. Subsequently, he started receiving treatment with secukinumab 150 mg/week [route not stated] for a total of five loading doses but he did not notice a major improvement in his symptoms. Therefore, in May 2019, the dosage was increased to 300mg once monthly. In November 2019 (after a total of eleven doses), he presented to an ophthalmologist with a painful red eye and cloudy vision. He was diagnosed with anterior uveitis secondary to a paradoxical reaction with secukinumab. The man was treated with unspecified corticosteroid eye drops for 2 months. He was reluctant to start systemic corticosteroids. He was maintained on secukinumab 150mg once monthly. By the first week of corrective treatment, his eye symptoms improved and by the fifth week, his uveitis completely resolved. His disease also remained controlled while he was maintained on secukinumab. Nadwi H, et al. New-onset uveitis possibly caused by secukinumab in a 47-year-old male patient with long-standing ankylosing spondylitis. International Medical Case 803502834 Reports Journal 13: 331-334, 05 Aug 2020. Available from: URL: http://doi.org/10.2147/IMCRJ.S265812
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Reactions 26 Sep 2020 No. 1823
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