Ixekizumab exposure associated with myelitis: A case report and a literature review

Marina Romozzi; Simone Bellavia; Giacomo Caldarola; Clara De Simone; Marco Luigetti; Paolo Calabresi; Massimiliano Di Filippo; Carlo Masullo; Matteo Lucchini

doi:10.1016/j.jneuroim.2021.577726

Ixekizumab exposure associated with myelitis: A case report and a literature review

J Neuroimmunol. 2021 Dec 15:361:577726. doi: 10.1016/j.jneuroim.2021.577726. Epub 2021 Sep 29.

Authors

Marina Romozzi¹, Simone Bellavia², Giacomo Caldarola³, Clara De Simone³, Marco Luigetti², Paolo Calabresi², Massimiliano Di Filippo⁴, Carlo Masullo², Matteo Lucchini²

Affiliations

¹ Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: marina.romozzi01@icatt.it.
² Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.
³ Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A Gemelli 8, 00168, Rome, Italy; Dipartimento di Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy.
⁴ Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy.

PMID: 34628135
DOI: 10.1016/j.jneuroim.2021.577726

Abstract

We describe a case of a 28-year-old man who developed a cervical myelitis while exposed to ixekizumab (IL-17 inhibitor) for psoriatic arthritis. Spinal MRI showed a T2 hyperintense lesion at the C4-C5 level while brain MRI was unspecific. Oligoclonal bands were absent and extensive screening for autoimmunity was negative. Rechallenge with ixekizumab was positive corroborating a relation between drug exposure and the neurological event. To the best of our knowledge, this is the first case of CNS inflammatory adverse event associated with ixekizumab. We also provide a review of case reports of demyelinating disorders associated with the use of biologic drugs for the treatment of psoriasis and psoriatic arthritis.

Keywords: CNS inflammation; IL-17; Ixekizumab; Myelitis; Psoriatic arthritis.

Publication types

Case Reports
Review

MeSH terms

Adolescent
Adrenal Cortex Hormones / therapeutic use
Adult
Antibodies, Monoclonal, Humanized / adverse effects*
Antibodies, Monoclonal, Humanized / therapeutic use
Antirheumatic Agents / adverse effects
Arthritis, Psoriatic / drug therapy
Brain Mapping
Drug Substitution
Female
Humans
Hypesthesia / chemically induced
Immunologic Factors / adverse effects*
Immunologic Factors / therapeutic use
Interleukin-17 / antagonists & inhibitors
Leg / innervation
Magnetic Resonance Imaging
Male
Middle Aged
Myelitis / chemically induced*
Myelitis / diagnostic imaging
Myelitis / drug therapy
Paresis / chemically induced
Spinal Cord / diagnostic imaging
White Matter / diagnostic imaging
White Matter / pathology
Young Adult

Substances

Adrenal Cortex Hormones
Antibodies, Monoclonal, Humanized
Antirheumatic Agents
IL17A protein, human
Immunologic Factors
Interleukin-17
ixekizumab