Treatment of necrobiosis lipoidica with secukinumab (Cosentyx): a case series

Abstract

Treatment of necrobiosis lipoidica with secukinumab (Cosentyx): a case series Dear Editor, Necrobiosis lipoidica (NL) is a chronic granulomatous disease with no current Food and Drug Administration-approved treatment. Previous published treatments have been small and inconsistent. IL-17 has been implicated in the pathogenesis of NL. 1 We report the use of secukinumab, a monoclonal antibody against IL-17A, for treating NL. Patients enrolled from April 3, 2019, to April 15, 2021, in an open label, proof of concept study (terminated early due to low enrollment during the COVID-19 pandemic). Inclusion criteria included age ≥18, history of biopsy-proven NL, and active NL lesions defined as clinical signs of inflammation or new/expanding lesions. Patients received secukinumab 300 mg subcutaneously weekly for 5 weeks then every 4 weeks for a total of 24 weeks. The primary endpoint was NL Investigator Global from the corresponding author, MP, upon reasonable request.

A Breakthrough in the Treatment of Necrobiosis Lipoidica? Update on Treatment, Etiopathogenesis, Diagnosis, and Clinical Presentation

“…The discovery of a key role for TNF- α in granuloma formation in mouse models provides a theoretical basis for explaining the efficacy of TNF-α inhibitors in granulomatous inflammatory diseases such as NL [ 74 , 75 ]. Although medications in this class have had a beneficial effect on many patients, there were cases reported that did not respond to treatment or the treatment had to be discontinued due to the loss of efficacy or adverse effects [ 76 , 77 , 78 , 79 ]. This has necessitated the search for new drugs effective in the treatment of necrobiosis lipoidica.…”

“…Wakusawa et al, in sections taken from NL lesions, revealed the presence of granulomas containing significant amounts of IL-17-releasing cells; therefore, this cytokine was associated with NL [ 85 ]. Gibson et al described four clinical cases of patients with treatment-resistant NL who received subcutaneous secukinumab for 24 weeks [ 78 ]. All patients responded to treatment, but the clinical improvement varied between patients (from about 25% to about 90% improvement).…”