Drug Action
Secukinumab is a recombinant human monoclonal antibody that selectively binds to cytokine interleukin-17A (IL-17A) and inhibits the release of proinflammatory cytokines and chemokines.
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Drug reference
Secukinumab is a recombinant human monoclonal antibody that selectively binds to cytokine interleukin-17A (IL-17A) and inhibits the release of proinflammatory cytokines and chemokines.
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Ankylosing spondylitis (initiated by a specialist) ▶BY SUBCUTANEOUS INJECTION ▶Adult: 150 mg every week for 5 doses, then maintenance 150 mg every month, review treatment if no response within 16 weeks of initial dose Psoriatic arthritis (initiated by a specialist) ▶BY SUBCUTANEOUS INJECTION ▶Adult: 150 mg every week for 5 doses, then maintenance 150 mg every month, dose may be increased to 300 mg according to clinical response. Review treatment if no response within 16 weeks of initial dose Psoriatic arthritis with concomitant moderate to severe plaque psoriasis or if inadequate response to anti-TNFa treatment (initiated by a specialist) | Plaque psoriasis (initiated by a specialist) ▶BY SUBCUTANEOUS INJECTION ▶Adult: 300 mg every week for 5 doses, then maintenance 300 mg every month, review treatment if no response within 16 weeks of initial dose
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Severe active infection
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Chronic infection. Crohn’s disease (monitor for exacerbations). history of recurrent infection. predisposition to infection (discontinue if new serious infection develops) CAUTIONS, FURTHER INFORMATION ▶Tuberculosis Manufacturer advises that patients with latent tuberculosis should complete anti-tuberculosis therapy before starting secukinumab.
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Musculoskeletal system NICE decisions ▶Secukinumab for treating moderate to severe plaque psoriasis (July 2015) NICE TA350 Secukinumab is recommended as an option for the treatment of moderate to severe plaque psoriasis in adults if: . the disease has failed to respond to standard systemic treatments (including ciclosporin, methotrexate, and PUVA), or when standard treatments are contra- indicated or not tolerated; and . the manufacturer provides secukinumab with the discount agreed in the patient access scheme Secukinumab should be withdrawn in patients whose psoriasis has not responded adequately within 12 weeks of initial dose; further treatment cycles are not recommended. Patients whose treatment with secukinumab was started before this guidance was published, but does not meet these criteria, should have the option to continue treatment until they and their clinician consider it appropriate to stop. www.nice.org.uk/TA350 ▶Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors (September 2016) NICE TA407 Secukinumab is recommended, within its marketing authorisation, as an option for treating active ankylosing spondylitis in adults who have responded inadequately to conventional therapy (non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors) only if the manufacturer provides secukinumab with the discount agreed in the patient access scheme. Assess response to secukinumab after 16 weeks of treatment and continue only if there is clear evidence of response, defined as a reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score to 50% of the pre-treatment value or by 2 or more units and a reduction in the spinal pain visual analogue scale (VAS) by 2 cm or more. www.nice.org.uk/TA407 ▶Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs (May 2017) NICE TA445 Secukinumab alone, or in combination with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults only if: . it is used as described in the NICE technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis (TA199 recommendations 1.1 and 1.2) or, . the person has had a tumour necrosis factor (TNF)-alpha inhibitor but their disease has not responded within the first 12 weeks or has stopped responding after 12 weeks or, . TNF-alpha inhibitors are contra-indicated but would otherwise be considered. Secukinumab is only recommended if the manufacturer provides it as agreed in the patient access scheme. Assess the response to secukinumab after 16 weeks of treatment. Treatment should only be continued if there is clear evidence of response, defined as an improvement in at least 2 of the 4 Psoriatic Arthritis Response Criteria (PsARC), 1 of which must be joint tenderness or swelling score, with no worsening in any of the 4 criteria. People whose disease has a Psoriasis Area and Severity Index (PASI) 75 response but whose PsARC response does not justify continuing treatment should be assessed by a dermatologist. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their clinician consider it appropriate to stop. www.nice.org.uk/guidance/TA445 Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (June 2015) that secukinumab (Cosentyx ®) is accepted for restricted use within NHS Scotland for the treatment of moderate to severe plaque psoriasis in adults who have failed to respond to standard systemic therapies (including ciclosporin, methotrexate and phototherapy), or when standard treatments cannot be used because of intolerance or contra-indications.
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→Appendix 1: monoclonal antibodies
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▶Common or very common Diarrhoea. increased risk of infection. rhinorrhoea ▶Uncommon Conjunctivitis. neutropenia (usually mild and reversible). urticaria ▶Rare or very rare Anaphylactic reaction
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Manufacturer advises that women of childbearing potential should use effective contraception during treatment and for at least 20 weeks after stopping treatment.
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Manufacturer advises avoid—no information available.
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Manufacturer advises avoid during treatment and for up to 20 weeks after discontinuing treatment—no information available.
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Manufacturer advises to take the syringe or pen out of the refrigerator 20 minutes before administration and to avoid injecting into areas of the skin that show psoriasis. Patients may self-administer Cosentyx ® pre-filled pen.
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Cosentyx (Novartis Pharmaceuticals UK Ltd) Secukinumab 150 mg per 1 ml Cosentyx 150mg/1ml solution for injection pre-filled pens | 2 pre-filled disposable injection P £1,218.78 Cosentyx 150mg/1ml solution for injection pre-filled syringes | 2 pre- filled disposable injection P s
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Self-administration Patients and their carers should be given training in subcutaneous injection technique. Infection Patients and their carers should be advised to seek immediate medical attention if symptoms of infection develop during treatment with secukinumab.
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150 mg every week for 5 doses, then
First-line fragment. Read the complete Indications and Dose section above.
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150 mg every week for 5 doses, then
First-line fragment. Read the complete Indications and Dose section above.
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300 mg every week for 5 doses, then
First-line fragment. Read the complete Indications and Dose section above.
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