Yes, patients living abroad can receive monthly maintenance dosing of secukinumab after completing the loading phase.
The standard maintenance regimen for secukinumab (Cosentyx) is 300 mg subcutaneous injection every 4 weeks after the initial loading phase, regardless of where the patient resides. 1
Standard Dosing Algorithm
Loading Phase (Weeks 0-4)
- 300 mg subcutaneous injection at weeks 0,1,2,3, and 4 1
Maintenance Phase (Week 8 onwards)
- 300 mg subcutaneous injection every 4 weeks 1
- This is a Grade A recommendation with Level I-II evidence 1
Key Considerations for Patients Living Abroad
Self-administration capability: Secukinumab is designed for self-administered subcutaneous injection, making it practical for patients who travel or live abroad 1
Do NOT extend dosing intervals beyond every 4 weeks: Evidence demonstrates that as-needed dosing or extended intervals (every 6 weeks) are significantly less effective than standard every 4-week maintenance dosing 1, 2. In the OPTIMISE study, every 6-week dosing resulted in only 74.9% PASI 90 maintenance versus 85.7% with every 4-week dosing (odds ratio 1.91, p<0.001) 2
Storage and transport: Ensure proper cold chain maintenance during international travel, as secukinumab requires refrigeration
When Treatment is Interrupted
If doses are missed due to travel or other reasons:
Consider repeating loading doses if:
- The patient is experiencing disease flare, AND/OR
- More than 3-4 half-lives have passed since the previous dose 1
The necessity of repeating loading doses depends on:
- Disease severity at time of reinitiation
- Number of doses missed 1
Common Pitfall to Avoid
Do not attempt to reduce dosing frequency to every 6-8 weeks simply for convenience of international travel. While some recent observational data suggest selected patients in deep remission may maintain response with extended intervals 3, the FDA-approved and guideline-recommended regimen remains every 4 weeks 1, 4. The OPTIMISE trial definitively showed that every 6-week dosing fails to maintain optimal disease control in the majority of patients 2.
Alternative Consideration
For patients who genuinely cannot maintain every 4-week dosing due to prolonged international residence, discuss switching to biologics with longer dosing intervals (e.g., guselkumab every 8 weeks, ustekinumab every 12 weeks) rather than extending secukinumab intervals 1.