New-Onset Ulcerative Colitis after Secukinumab Initiation: A Case Report

Secukinumab is an anti-interleukin (IL)-17 used in the treatment of rheumatological conditions such as ankylosing spondylitis and psoriasis. Despite elevated IL-17A levels in inflammatory bowel disease (IBD) patients, clinical trials suggest IL-17 inhibition may exacerbate disease activity in IBD. Multiple sclerosis (MS) also has a suspected association with IBDs.

A 22-year-old man who has a paternal grandfather with a history of MS was started on secukinumab for suspected ankylosing spondylitis. Three months after secukinumab initiation, he developed new gastrointestinal (GI) symptoms and was diagnosed with ulcerative colitis. He responded to a course of corticosteroids, and his secukinumab was stopped. He remains in clinical and endoscopic remission 5 months after completing his course of steroids.

This case highlights the potential association between IL-17 inhibition and new-onset IBD in a patient with a family history of MS and illustrates a compelling clinical dilemma regarding the initial selection of biologic therapy in a patient with multiple autoimmune risk factors. Before starting an anti-IL-17 agent, physicians should review the patient's personal and family history of IBD, as well as other risk factors, including immune-mediated conditions such as MS that may increase IBD risk. Patients should then be closely monitored for the development of any new GI symptoms.