Coronavirus disease 2019 (COVID-19) in a patient with ankylosing spondylitis treated with secukinumab: a case-based review

Abstract

Severe acute respiratory syndrome coranovirus-2 (SARS-CoV-2) infection has become an important health-care issue worldwide. The coronavirus disease 2019 (COVID-19) has also raised concerns among patients with inflammatory rheumatic conditions and their treating physicians. There are emerging data regarding the potential risks of SARS-CoV-2 for this particular patient group. However, less is known with regard to the course of COVID-19 among patients receiving IL-17 inhibitors. The aim of the current article is to review the growing body of knowledge on the course/management of COVID-19 in patients with inflammatory rheumatic diseases by presenting a SARS-CoV-2 infected case with ankylosing spondylitis under secukinumab therapy. A 61-year old patient with ankylosing spondylitis who was on secukinumab therapy for 5 months admitted with newly onset fever and gastrointestinal complaints. After being hospitalized, she developed respiratory manifestations with focal pulmonary ground-glass opacities and multiple nodular densities in both lungs. The patient was tested positive for SARS-CoV-2 infection. Substantial clinical improvement was obtained following a management plan, which included tocilizumab, hydroxychloroquine, prednisolone and enoxaparin sodium. PubMed/MEDLINE and Scopus databases were searched by using relevant keywords and their combinations. The literature search revealed four articles reporting the clinical course of COVID-19 in seven rheumatic patients on secukinumab. The clinical course of SARS-CoV-2 infection was mild in most of these patients, while one of them experienced severe COVID-19. Interleukin-17 has been related to the hyperinflammatory state in COVID-19 and IL-17 inhibitors were presented as promising targets for the prevention of aberrant inflammation and acute respiratory distress in COVID-19. However, this hypothesis still remains to be proved. Further studies are warranted in order to test the benefits and risks of IL-inhibitors in SARS-CoV-2 infected individuals.

Keywords: Ankylosing spondylitis; Biological drugs; COVID-19; Interleukin-17; Rheumatic diseases; Secukinumab; Spondyloarthritis.

Fig. 1

Timeline of the disease course

Fig. 2

Flowchart of the case-based review. COVID-19: coronavirus disease 2019, SARS-C0V-2: severe acute respiratory syndrome coronavirus-2, DMARD: disease modifying anti-rheumatic drug. * Initial search was done on May 9, 2020 by using the provided keywords. To retrieve more recent articles, a second search was performed on June 12, 2020 by using the keywords “secukinumab”, “coronavirus disease 2019”, and “SARS-CoV-2”. Relevant items were further included

Fig. 3

The potential contribution of IL-17A to the hyperinflammatory state in SARS-CoV-2 infection. SARS-C0V-2 severe acute respiratory syndrome coronavirus-2, APC antigen presenting cell, CD cluster of differentiation, Th17 T helper 17, IL interleukin, TNF-α tumor necrosis factor-alpha, CXCL10 CXC-motif chemokine ligand 10, MIP-2α macrophage inflammatory protein 2-alpha, MMP matrix metalloproteinase, CCL2 CC-motif chemokine ligand 2, GM-CSF granulocyte monocyte colony stimulating factor