Secukinumab-induced hepatitis and renal vasculitis

Dear Editor, Secukinumab (Cosentyx, Novartis) is an interleukin-17A (IL-17A) inhibitor used to manage inflammatory conditions such as ankylosing spondylitis. While it is considered to have a favourable safety profile, this report describes two unprecedented cases where patients developed serious complications—autoimmune hepatitis and renal vasculitis—associated with secukinumab. These are the first known cases reported in medical literature and have been submitted via the UK’s Yellow Card Scheme to document suspected drug-related adverse effects. The first case involves a 52-year-old female diagnosed with HLA-B27-positive ankylosing spondylitis. She began secukinumab therapy in December 2018 and was with no co-morbidities or concurrent medications. For over 2 years, she tolerated the drug well, with significant disease control. In June 2021, routine blood work showed elevated alanine aminotransferase (ALT) at 156 (Fig. 1A), suggesting liver involvement despite the patient being asymptomatic. Detailed workup by the hepatologist to include hepatitis (B and C) screen and autoimmune liver screen was completely unremarkable other than a positive ANA at a titre of 1:1600 with anti-La antibodies. A liver biopsy demonstrated moderate to heavy portal inflammatory infiltrates, bile duct damage, granuloma formation, interface hepatitis and portal fibrosis—features consistent with autoimmune hepatitis or drug-induced liver injury (DILI). Notably, her ANA had been negative prior to initiating secukinumab, and there were no other plausible causes identified.