Secukinumab for NLD (Cosentyx) in Patients With Necrobiosis Lipoidica Diabeticorum (NLD)

Necrobiosis lipoidica diabeticorum (NLD) is a rare granulomatous condition of the skin often
presenting with papules and eventually atrophic plaques, most commonly on the distal extensor
lower extremities, which can be painful and disfiguring. Currently no FDA-approved treatment
exists, and no well-established treatment algorithm has been described. Reports on successful
therapeutic interventions have generally been small and inconsistent.

Recent literature expanding on the previously poorly understood pathogenesis of NLD has
suggested a potential role for IL-17 in the development of this condition. Thus blockade of
IL-17 may be a potential therapeutic strategy in patients with NLD. Secukinumab (Cosentyx) is
a human monoclonal antibody that targets IL-17a and is FDA approved for the treatment of
psoriasis.

This open-label, proof of concept study regarding the use of Secukinumab in patients with NLD
may be a first step in elucidating and defining a treatment for this chronic and potentially
debilitating condition for which no FDA approved treatment currently exists.

Inclusion Criteria:

- Adults, age 18 and over

- Previous diagnosis of biopsy-proven NLD

- Active NLD lesions, defined as

- clinical signs of inflammation, for example erythematous margins, sensations of
itch, pain, dysaesthesia

- lesions increasing in size or appearance of new lesions within the last 3 months

- ulcerations

- Subjects must be able to understand and communicate with the investigator and comply
with the requirements of the study and must give a written, signed and dated informed
consent before any study related activity is performed.

Exclusion Criteria:

- History of an ongoing, chronic or recurrent infectious disease, or evidence of
tuberculosis infection as defined by a positive QuantiFERON TB-Gold test at screening.

- Are currently pregnant, breastfeeding, or planning to get pregnant during the study.

- Previous hypersensitivity reaction to secukinumab or to any of the components.

- History of Inflammatory Bowel Disease (Crohn's Disease or Ulcerative Colitis)

- Allergy to Latex

- Currently on any other immunosuppressant systemic medication or within 28 days of
baseline visit

- Women of child-bearing potential, defined as all women physiologically capable of
becoming pregnant, unwilling to use effective contraception during the study and for
16 weeks after stopping treatment.

- Subjects with a serum creatinine level exceeding 176.8 μmol/L (2.0 mg/dL)

- Screening total WBC count <2,500/μL, or platelets <100,000/μL or neutrophils <1,500/μL
or hemoglobin <8.5 g/dL

- Known infection with HIV, hepatitis B or hepatitis C at screening or randomization.
Patients who are Hepatitis B Core antibody and/or Hep B Surface Antigen positive will
be excluded from this study. Patients who are Hepatitis C ab positive will also be
excluded from this study.

- History of lymphoproliferative disease or any known malignancy or history of
malignancy of any organ system within the past 5 years (except for non-melanoma skin
cancer and carcinoma in situ of the cervix)

- Are participating in another study using an investigational agent or procedure during
participation in this study or within 28 days prior to baseline visit.

- Plans for administration of live vaccines during the study period or 6 weeks prior to
randomization

- Any other procedural treatment for NLD with 28 days prior to baseline visit, including
phototherapy, surgical intervention, laser therapy, or cryotherapy.

- Any other active skin disease or condition (e.g., bacterial, fungal or viral
infection) that may interfere with assessment of NLD;

- Underlying condition (including, but not limited to metabolic, hematologic, renal,
hepatic, pulmonary, neurologic, endocrine, cardiac, infectious or gastrointestinal)
which in the opinion of the investigator significantly immunocompromises the subject
and/or places the subject at unacceptable risk for receiving an immunomodulatory
therapy