Side effects of Anti IL-17 A in the ENT domain

Immunomodulatory drugs such as Secukinumab (Anti IL-17 A) have allowed new treatment options for diseases such as ankylosing spondylitis. By targeting cytokines involved in T-cell based immune mechanisms their physiological functions such as defense against extracelluar pathogens are also impaired. To evaluate whether Anti IL-17 A treatment leads to an increased number of complications in the ENT domain we analyzed data from patients who had undergone tratment in our clinic over the last 4 years. There was a complex otologic infection in a 27 year old patient with acute otitis media, who after initial recovery under treatment according to the guidelines and a symptom free interval of 4 weeks developed acute mastoiditis and underwent mastoidectomy. C. albicans was found in the external auditory canal and antimycotic treatment started. A prolonged orbital complication of acute sinusitis occurred in a 53 year old patient. Although the patient initially recovered under systemic antibiotic treatment and endoscopic sinus surgery she presented herself 6 weeks later with multiple intraorbital abscesses for which repeated surgeries were necessary. In microbiologic examination S. viridans was found. A 48 year old patient had severe Ludwig’s angina with prolonged intubation and multipe surgical abscess incisions and drainages. Serologic testing revealed reactivation of VZV so that tratment with acyclovir was started. After pausing and a wash-out of Secukinumab no further complications occurred in these patients. We suggest that Secukinumab may have contributed to the prolonged course of these treatment refractory diseases by suppressing IL-17A. Also the occurrence of opportunistic infections may have been facilitated by its modulation of T-cell based immune mechanisms.

Publication History

Article published online:
12 May 2023