IL-17A inhibitor-induced leucocytoclastic vasculitis is responsive to IL-23 blockade in a psoriatic arthritis patient.

Binod, K C; Jabbour, Austin; Poudel, Pooja; Banki, Katalin; Perl, Andras · Ann Rheum Dis · 2024

case_report · Level V

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Abstract

Secukinumab is monoclonal antibody that targets interleukin 17 (IL-17) for treatment of psoriatic arthritis, psoriasis, and ankylosing spondylitis. We herein present a psoriatic arthritis patient who developed leukocytoclastic vasculitis (LCV) following treatment with secukinumab. Genetic studies identified amino acid changes in two different IL-17 receptors, IL-17RA and IL-17-RC, and interacting DOCK8, Rab27A, and STX1 proteins. LCV completely resolved after withdrawal of the drug, transient treatment with dapsone and methylprednisolone, and switching to long-term therapy to IL-23 inhibitor tildrakizumab. This case reveals potential molecular bases of disease pathogenesis, intolerance of IL-17 blockade, and responsiveness to IL-23 inhibition in psoriatic arthritis.

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