Cosentyx (Secukinumab) for Hidradenitis Suppurativa Treatment
Yes, Cosentyx (secukinumab) is FDA-approved and effective for treating hidradenitis suppurativa, with the recommended dose being 300 mg monthly by subcutaneous injection, which can be increased to 300 mg every 2 weeks based on clinical response. 1, 2
Dosing Regimen
Loading Phase
- Weeks 0,1,2,3, and 4: Administer 300 mg subcutaneously (given as two 150 mg injections or one 300 mg injection) 1
Maintenance Phase
- Standard maintenance: 300 mg monthly (every 4 weeks) starting at week 5 1
- Intensified maintenance: 300 mg every 2 weeks if inadequate response to monthly dosing 1
Treatment Duration Considerations
- Evaluate response at week 16; consider discontinuation if no response by this timepoint 1
- However, real-world data suggests evaluating at both weeks 16 and 24 is crucial, as some patients show delayed response 3
Efficacy Data
Clinical Trial Results
The SUNSHINE and SUNRISE phase 3 trials demonstrated:
- Every 2 weeks dosing: 42-45% of patients achieved HiSCR (Hidradenitis Suppurativa Clinical Response) at week 16 4
- Every 4 weeks dosing: 42-46% achieved HiSCR at week 16 4
- Placebo: 31-34% achieved HiSCR 4
- Response was sustained through week 52 with continued treatment 4
Real-World Performance
Real-world data shows even better outcomes than clinical trials:
- 63.6% achieved HiSCR50 at week 24 in a 263-patient multicenter study 3
- 56% achieved IHS4-55 response (≥55% reduction in International HS Severity Score) at week 24 3
- Mean IHS4 score decreased from 16.7 at baseline to 7.6 at week 24 3
Safety Considerations
Contraindications
- Absolute: Hypersensitivity to secukinumab or excipients; clinically important active infection 1
Critical Warnings
Infections:
- Increases risk of infections, including serious infections 1
- Screen for tuberculosis before initiating; do not give if active TB present 1
- Consider anti-TB therapy for latent TB before starting 1
- Monitor closely and discontinue if serious infection develops 1
- Non-serious mucocutaneous candida infections occur more frequently 1
Inflammatory Bowel Disease:
- Secukinumab is NOT recommended in patients with inflammatory bowel disease (Crohn's disease or ulcerative colitis) 1
- New cases or exacerbations have been reported 1
- Discontinue if patient develops IBD signs/symptoms 1
Pregnancy and Lactation
- Pregnancy: Preferably avoid; use only if benefit outweighs risk 1
- Contraception: Women of childbearing potential should use effective contraception during treatment and for at least 20 weeks after discontinuation 1
- Breastfeeding: Unknown if excreted in breast milk; make clinical decision weighing benefits to mother vs. infant 1
- Per recent HS guidelines, exercise caution with anti-IL-17s in breastfeeding given minimal available data 5
Common Adverse Events
- Headache (8-12% of patients) 4
- Generally well-tolerated with safety profile consistent with other approved indications 4
- In real-world studies: 17% reported adverse effects, 14.5% discontinued due to lack of efficacy or adverse events 6, 3
Clinical Pearls
Patient Selection
- Effective in both biologic-naïve and biologic-experienced patients 7
- Particularly valuable for patients who failed TNF-α inhibitors (adalimumab) 7
- Works across all Hurley stages, including severe stage III disease 3
Monitoring Strategy
- Assess response at week 16 AND week 24 rather than week 16 alone, as some patients show delayed response 3
- Nearly 40% of week 12 non-responders achieved response by week 36 with continued treatment in clinical trials 4
- Don't discontinue prematurely if partial response is evident
Adjunctive Therapy
- Patients should use daily topical over-the-counter antiseptics on affected areas during treatment 4
- Can be combined with topical or systemic therapies, though no published data exists on combinations 8