Worsening of Pulmonary Sarcoidosis Induced by Ixekizumab: A Rare Paradox

Sambharia, Meenakshi; Magge, Tara; Ramakrishna, S.

doi:10.1016/j.chest.2018.08.808

Cited by 6 publications

(4 citation statements)

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“…A prior case report has identified drug-induced sarcoidosis with primarily pulmonary involvement. 3,5 Our case reports highlight identification of possible ixekizumab-induced cardiac sarcoidosis. The clinical timeline of our patient, including improvement upon removal of the offending agent within 10 weeks, provides strong evidence supporting a case of possible druginduced cardiac sarcoidosis.…”

Section: Discussionmentioning

confidence: 78%

“…On day 9 of hospitalization, the patient underwent endobronchial ultrasound-guided fine-needle aspiration of lymph node station 7, with pathology demonstrating non-necrotizing granulomas, with negative culture and no malignant cells seen, concerning for sarcoidosis. Due to a previous report of ixekizumab-induced pulmonary sarcoidosis, 3 this medication was discontinued. High-intensity steroids were deferred, as the patient was stable.…”

Section: Case Presentationmentioning

confidence: 99%

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Ixekizumab-Induced Cardiac Sarcoidosis: A Case Report

et al. 2021

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A 58-year-old man with a history of hypertension and psoriasis presented with acute-onset heart failure with an ejection fraction of 25%-30%. During the work-up, cardiac magnetic resonance imaging showed a pattern of inflammation consistent with sarcoidosis, which was confirmed with (18)F-fluorodeoxyglucose positron emission tomography . The patient was recently initiated on ixekizumab for psoriasis, which was then discontinued. This discontinuation resulted in complete resolution of cardiac sarcoidosis, with establishment of normal ejection fraction. This result suggests a potential causal association of ixekizumab-induced cardiac sarcoidosis, which is a rare phenomenon. Elucidation of the mechanism behind the effect of ixekizumab may provide insights into the possible mechanism(s) behind cardiac sarcoidosis.

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Section: Discussionmentioning

confidence: 78%

Section: Case Presentationmentioning

confidence: 99%

Ixekizumab-Induced Cardiac Sarcoidosis: A Case Report

et al. 2021

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“…Previous reports suggest a favorable effect of secukinumab in two cases of sarcoidosis associated with TNF antagonists (55,56). Conversely, our review of the literature identified two cases of sarcoidosis that either developed or worsened in patients taking secukinumab and ixekizumab (57,58). However, a previous multicentre, randomized, double blind, phase II trial, assessing the efficacy and safety of secukinumab in non-infectious uveitis did not identify any safety concerns in the included patients with sarcoidosis (n = 4) (59).…”

Section: Interleukin-17 Blockingmentioning

confidence: 73%

Emerging Molecular Targets for the Treatment of Refractory Sarcoidosis

et al. 2020

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Sarcoidosis is a multisystem granulomatous disease of unknown origin that has variable clinical course and can affect nearly any organ. It has a chronic course in about 25% of patients. Corticosteroids (CS) are the cornerstone of therapy but their long-term use is associated with cumulative toxicity. Commonly used CS-sparing agents include methotrexate, cyclophosphamide, azathioprine, and mycophenolate mofetil. Twenty to forty percentage of sarcoidosis patients are refractory to these therapies or develop severe adverse events. Therefore, additional and targeted CS-sparing agents are needed for chronic sarcoidosis. Macrophage activation, interferon response, and formation of the granuloma are mainly mediated by T helper-1 responses. Different pro-inflammatory cytokines such as interleukin (IL)-8, IL-12, IL-6, and tumor necrosis factor-alpha (TNF-α) have been shown to be highly expressed in sarcoidosis-affected tissues. As a result of increased production of these cytokines, Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling is constitutively active in sarcoidosis. Several studies of biological agents that target TNF-α have reported their efficacy and appear today as a second line option in refractory sarcoidosis. Some case series report a positive effect of tocilizumab an anti-IL-6 monoclonal antibody in this setting. More recently, JAK inhibition appears as a new promising strategy. This review highlights key advances on the management of chronic refractory sarcoidosis. Novel therapeutic strategies and treatment agents to manage the disease are described.

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“…Two similar cases have been described previously: one with new-onset sarcoidosis on secukinumab and one with worsening of sarcoidosis on ixekizumab. 2,3 There have also been two reports of granuloma annulare occurring on IL-17 inhibitors. 4,5 Interestingly, IL-17 inhibitors are well known to induce or worsen Crohn's disease (CD), in which granuloma formation is common.…”

Section: Development or Worsening Of Sarcoidosis Associated With Il-1mentioning

confidence: 99%

Development or worsening of sarcoidosis associated with IL‐17 blockade for psoriasis

Hornick

Wang

Lim

et al. 2020

Acad Dermatol Venereol

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app for risk assessment of pigmented and non-pigmented skin lesions-a study on sensitivity and specificity in detecting malignancy. Telemed J E Health 2017; 23: 948-954. 7 SkinVision. [WWW document]. URL https://www.skinvision.com/news/ skinvision-to-join-nhs-innovation-accelerator (last accessed: 26 May 2020). 8 Freeman K, Dinnes J, Chuchu N et al. Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies. BMJ 2020; 368: m127.

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Worsening of Pulmonary Sarcoidosis Induced by Ixekizumab: A Rare Paradox

Cited by 6 publications

References 0 publications

Ixekizumab-Induced Cardiac Sarcoidosis: A Case Report

Ixekizumab-Induced Cardiac Sarcoidosis: A Case Report

Emerging Molecular Targets for the Treatment of Refractory Sarcoidosis

Development or worsening of sarcoidosis associated with IL‐17 blockade for psoriasis

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