Interstitial Lung Disease Induced by Monoclonal Antibodies for Psoriatic Arthritis, a Double Hit: A Case Report with a Literature and Clinical Trial Review.

INTRODUCTION: Monoclonal antibodies (mAb) play a central role in modern medicine; however, several of them have been associated with the development of drug-induced interstitial lung diseases (ILD). We present a case of a patient affected by psoriatic arthritis (PsA) treated with secukinumab, an anti-IL17 mAb, who developed a histological organising pneumonia pattern with microgranulomas. After resolution, the patient relapsed when exposed to guselkumab, an anti-IL23 mAb, with further histological confirmation. Treatment withdrawal and steroids resolved the ILD in both cases. To evaluate the risk of developing ILD in the context of those two drugs, we also performed a review of the literature and the clinical trials for the drugs in PsA. METHODS: Papers presenting drug-induced ILD in patients treated with secukinumab and/or guselkumab in PubMed and Embase were searched and summarised. Respiratory-related adverse events reported in secukinumab and guselkumab clinical trials for PsA were summarised. RESULTS: We summarised seven papers, finding a rare presentation (between 0.1% and 0.5%) of ILD in the treated population. The majority of the patients resolved the ILD after treatment withdrawal, with or without steroid treatment. In the clinical trials, respiratory-related adverse events were rarely reported, with only one case of ILD and one case of interstitial abnormalities at CT scan. CONCLUSIONS: This is the first case, to the best of our knowledge, that experienced a double hit from two different mAbs used for the treatment of PsA, secukinumab and guselkumab. Summarising the available literature and the reported adverse events for these two drugs, we also describe how, even in rare cases, mAbs in the context of PsA should raise suspicion of ILDs whenever the patient exhibits new respiratory symptoms.