Grimaux X, Leducq S, Goupille P, Aubourg A, Miquelestorena-Standley E, Samimi M
Université François-Rabelais, 37000 Tours, France; Service de dermatologie, CHU, hôpital Trousseau, 37044 Tours cedex, France.
Université François-Rabelais, 37000 Tours, France; Service de rhumatologie, CHU, hôpital Trousseau, 37044 Tours cedex, France.
Ann Dermatol Venereol. 2018 Nov;145(11):676-682. doi: 10.1016/j.annder.2018.07.009. Epub 2018 Oct 23.
Secukinumab, a humanized monoclonal antibody targeting interleukin 17A, has been associated with the development of inflammatory bowel diseases. We report a case of a female patient developing recurrent oral ulcers prior to inflammatory bowel disease induced by secukinumab. The patient had developed similar oral ulcers 6 years earlier while on tocilizumab (targeting IL6R), suggesting an immunological link between the two episodes.
A 36-year-old female patient had refractory spondylarthrosis. In 2010, she had presented oral aphthous ulcers during treatment with tocilizumab. In 2011, tocilizumab was stopped and the ulcers resolved. In 2016, secukinumab was introduced and led to recurrence of oral aphthous ulcers followed by ileitis-pancolitis. Corticosteroids and ustekinumab resulted in partial remission.
The patient developed inflammatory bowel disease during treatment with secukinumab, preceded by recurrent oral aphthous ulcers. She had presented similar oral ulcers 6 years earlier while on a treatment targeting IL6R. IL6 is a pleiotropic cytokine that may activate the Th17 pathway. Thus, tocilizumab could have induced an "anti-IL17-like" effect, accounting for the occurrence of oral aphthous ulcers, possibly related to mild inflammatory bowel disease.
The occurrence of oral ulcers during treatment with secukinumab may herald inflammatory bowel disease. In patients with a previous history of recurrent aphthous stomatitis, especially where induced by previous biologics, consideration must be given to the risk-benefit ratio of prescribing an anti-IL17 antibody.
司库奇尤单抗是一种靶向白细胞介素17A的人源化单克隆抗体，与炎症性肠病的发生有关。我们报告一例女性患者，在司库奇尤单抗诱发炎症性肠病之前出现复发性口腔溃疡。该患者6年前在使用托珠单抗（靶向IL6R）时也曾出现类似口腔溃疡，提示这两次发作之间存在免疫关联。
一名36岁女性患者患有难治性脊柱关节炎。2010年，她在使用托珠单抗治疗期间出现口腔阿弗他溃疡。2011年，停用托珠单抗后溃疡消退。2016年，开始使用司库奇尤单抗，随后出现口腔阿弗他溃疡复发，继而发展为回肠炎-全结肠炎。使用皮质类固醇和优特克单抗后病情部分缓解。
该患者在使用司库奇尤单抗治疗期间发生炎症性肠病，之前有复发性口腔阿弗他溃疡。她6年前在使用靶向IL6R的药物治疗时也曾出现类似口腔溃疡。IL6是一种多效性细胞因子，可能激活Th17途径。因此，托珠单抗可能诱导了一种“抗IL17样”效应，导致口腔阿弗他溃疡的发生，可能与轻度炎症性肠病有关。
司库奇尤单抗治疗期间出现口腔溃疡可能预示着炎症性肠病。对于既往有复发性阿弗他口炎病史的患者，尤其是既往生物制剂诱发的患者，必须考虑使用抗IL17抗体的风险效益比。
