# Case Report: Switching secukinumab to bimekizumab in diffuse cutaneous systemic sclerosis after autologous hematopoietic stem cell transplantation: a case follow-up

## TL;DR

A patient with diffuse cutaneous systemic sclerosis showed improvement after switching from secukinumab to bimekizumab, which inhibits more IL-17 pathways.

## Contribution

This case suggests broader IL-17 inhibition may help patients with refractory skin symptoms after stem cell transplants.

## Key findings

- The patient experienced a flare of skin symptoms while on secukinumab.
- Switching to bimekizumab led to resolution of symptoms and improved skin scores.
- Mild oral candidiasis was the only reported adverse event.

## Abstract

Diffuse cutaneous systemic sclerosis (dcSSc) is a heterogeneous autoimmune disease characterized by progressive skin fibrosis, vasculopathy and variable organ involvement. Our recent case report about this patient described clinical improvement under IL-17A inhibition with secukinumab for worsening of cutaneous involvement after autologous hematopoietic stem-cell transplantation. We present the extended disease course through 2025. In July 2025 the patient presented with a new flare characterized by cutaneous tightening, dysesthetic sensory symptoms and intermittent pruritus despite ongoing secukinumab therapy. Given the early signs of renewed cutaneous progression and with the aim of preventing further deterioration, treatment was switched to bimekizumab, a dual IL-17A/IL-17F inhibitor. By November 2025 the patient demonstrated resolution of cutaneous symptoms, improvement of modified Rodnan skin score and improved joint stiffness. A single adverse event was mild oral candidiasis. This case follow-up suggests that broader IL-17 pathway inhibition may represent a promising therapeutic approach for selected patients with refractory inflammatory cutaneous manifestations of dcSSc.