Secukinumab: A safe option to treat psoriasis and psoriatic arthritis in the presence of interstitial lung disease

Abstract

Psoriasis is a commonly encountered skin condition with a significant percentage of patients developing arthritis. Psoriasis is associated with multiple comorbid conditions. However, the association of interstitial lung disease (ILD) with psoriasis is rarely reported in the literature. The therapeutic options for psoriasis and psoriatic arthritis are limited in the presence of ILD. We report a 63-year-old female with long-standing psoriasis and psoriatic arthritis with usual interstitial pneumonia pattern ILD. She developed severe arthritis and extensive psoriasis lesions which did not respond to conventional disease-modifying drugs as well as to oral phosphodiesterase inhibitor apremilast. She was planned for biological therapy. Antitumor necrosis factor therapy was not administered in view of coexistent ILD. She was treated with anti-interleukin-17 A monoclonal antibody, secukinumab 150 mg subcutaneous at 0, 1, 2, 3, and 4 weeks, followed by monthly once for 5 months for a total of ten doses. She had a resolution of skin lesions, and her arthritis went into remission. She had no clinical or radiological worsening of ILD. Spirometry showed improvement in forced vital capacity. This case report suggests that secukinumab can be safely used in psoriasis and psoriatic arthritis without worsening of underlying ILD.