Is the use of secukinumab after anti-TNF therapy greater than expected for the risk of developing inflammatory bowel disease? / El uso de secukinumab tras la terapia anti-TNF es mayor de lo esperado por el riesgo de desarrollar enfermedad inflamatoria intestinal?

Objective: In this study, our objective was to present real-life data on the incidence of inflammatory bowel disease (IBD) among patients receiving secukinumab treatment. Methods: The study consisted of 209 patients who had prior exposure to anti-tumor necrosis factor (TNF) or were biologically naive. Patients with a pre-existing history of IBD were excluded from the study. Results: Of the 209 patients in the study, 176 (84.3%) had ankylosing spondylitis, while 33 (15.7%) had psoriatic arthritis. 112 (53.6%) patients had prior exposure to at least one anti-TNF treatment before initiating secukinumab. IBD developed in 10 (4.8%) of the 209 patients. The incidence of IBD among patients who initiated secukinumab as their first biologic agent was 1%. For patients who had previously received any anti-TNF treatment and subsequently transitioned to secukinumab, the incidence of IBD was 8% (p=0.018, odds ratio (OR): 8.38, 95% CI: 1.04–67.45). A mean of 3.67 months (±4.3) after anti-TNF use, whereas IBD symptoms developed in the biologically naive patient after 15 months. Conclusion: Our study observed IBD incidence in 4.8% of patients using secukinumab. Patients who initiated secukinumab after previous anti-TNF treatment exhibited a significantly higher rate and risk of developing IBD. The onset of IBD occurred earlier in these patients (mean 3.67 months), whereas a single case of IBD showed a longer duration (15 months). Further studies with larger patient numbers are warranted to provide a more comprehensive understanding of our findings.(AU)

Objetivo: En este estudio, nuestro objetivo fue presentar datos de la vida real sobre la incidencia de la enfermedad inflamatoria intestinal (EII) entre los pacientes que reciben tratamiento con secukinumab. Métodos: El estudio consistió en 209 pacientes que habían tenido una exposición previa al factor de necrosis antitumoral (TNF) o eran biológicamente naive. Los pacientes con antecedentes preexistentes de EII fueron excluidos del estudio. Resultados: De los 209 pacientes del estudio, 176 (84,3%) tenían espondilitis anquilosante, mientras que 33 (15,7%) tenían artritis psoriásica. 112 (53,6%) pacientes tenían exposición previa a al menos un tratamiento anti-TNF antes de iniciar secukinumab. La EII se desarrolló en 10 (4,8%) de los 209 pacientes. La incidencia de EII entre los pacientes que iniciaron secukinumab como primer agente biológico fue del 1%. Para los pacientes que habían recibido previamente algún tratamiento anti-TNF y posteriormente hicieron la transición a secukinumab, la incidencia de EII fue del 8% (p=0,018, odds ratio (OR): 8,38, IC del 95%: 1,04-67,45). Una media de 3,67 meses (±4,3) después del uso de anti-TNF, mientras que los síntomas de la EII se desarrollaron en el paciente biológicamente naive después de 15 meses. Conclusión: Nuestro estudio observó una incidencia de EII en el 4,8% de los pacientes que usaban secukinumab. Los pacientes que iniciaron secukinumab después de un tratamiento anti-TNF previo mostraron una tasa y un riesgo significativamente mayores de desarrollar EII. El inicio de la EII ocurrió antes en estos pacientes (media de 3,67 meses), mientras que un solo caso de EII mostró una duración más prolongada (15 meses). Se justifican más estudios con un mayor número de pacientes para proporcionar una comprensión más completa de nuestros hallazgos.(AU)

Detection of the regression on hydroxychloroquine retinopathy in optical coherence tomography.

Hydroxychloroquine (HCQ) that is widely used in the treatment of the connective tissue disorders can cause retinopathy. The fundus examination of a patient with systemic lupus erythematosus receiving HCQ revealed left incomplete bull's eye and pigmentary changes in macula in the right eye. Repeated visual field tests showed the paracentral and peripheral defects in the right eye and the pericentral ring scotoma in the left eye. Optical coherence tomography (OCT) scans revealed the photoreceptor loss, retina pigment epithelium (RPE) irregularities, and a cyst-like hypo reflective space over RPE layer on the nasal perifoveal region in the left eye. On the ophthalmoscopic examination, the perifoveal pigmentation was not altered after the discontinuation of HCQ. However, the bilateral visual field defects were improved and the photoreceptor destruction and cyst-like hyporeflective space disappeared in the left eye. Mild RPE irregularities remained in both eyes as revealed by OCT scans. Even if OCT is used to evaluate the regression of HCQ retinopathy, it only shows advanced stage of retinopathy.

Osteoporosis associated with gyrate atrophy: a case report.

Gyrate atrophy (GA) is a rare degenerative, hereditary disease characterized by markedly high serum ornithine levels resulting from the deficiency of ornithine-delta-amino transferase (OAT), a mitochondrial matrix enzyme. Hyperornithinaemia is accompanied by lysinuria and reduced lysine plasma levels in GA. Type I collagen is known to play a role in osteoporosis pathogenesis. Lysine has a role in cross ligament formation of type I collagen, a bone matrix element, and thus, in bone strength. Although the most common complaint in GA is visual problems, the disease may include muscle involvement, as well. Reduced physical activity resulting from muscle involvement and hypolysinemia in GA may lead to osteoporosis. However, there is no data in the literature concerning the relation between GA and osteoporosis. In this report a GA case with early osteoporosis, besides visual deterioration and muscular signs, is reported, and the relation between GA and osteoporosis is emphasized for the first time.