Treatment experience with secukinumab in two patients with ankylosing spondylitis and concomitant active tuberculosis

Patients with ankylosing spondylitis (AS) may require biological therapy, particularly tumour necrosis factor (TNF) inhibitors, which are effective but increase the risk of tuberculosis (TB). Secukinumab, an interleukin-17A inhibitor, has not been linked to TB reactivation; however, its safety in the setting of active TB remains unclear. We report two patients with AS who developed active TB during long-term anti-TNF treatment. Both experienced disease flares while receiving anti-TB therapy and needed alternative biologic treatment. Secukinumab was started 2 months after initiating standard four-drug TB therapy and achieved rapid and sustained control of AS activity without compromising TB management. Both patients completed 9 months of anti-TB treatment without adverse events or TB reactivation during 1 year follow-up. These observations suggest that secukinumab may be a safe and effective therapeutic option for patients with AS with concomitant active TB when anti-TNF agents are contraindicated, though confirmation in larger studies is warranted.