Recommended Dosage for Cosentyx (Secukinumab) in Ankylosing Spondylitis
For ankylosing spondylitis, the recommended dose of Cosentyx is 150 mg administered subcutaneously at weeks 0,1,2,3, and 4, followed by monthly maintenance dosing. The dose can be increased to 300 mg based on clinical response. 1
Dosing Protocol for Ankylosing Spondylitis
Initial Loading Dose
- Administer 150 mg subcutaneously at:
- Week 0
- Week 1
- Week 2
- Week 3
- Week 4
Maintenance Dosing
- Continue with 150 mg subcutaneously every 4 weeks (monthly)
- If response is inadequate, consider increasing to 300 mg every 4 weeks 1
Administration Methods
- Each 150 mg dose is given as one injection of 150 mg
- Each 300 mg dose is given as either:
- Two injections of 150 mg, or
- One injection of 300 mg (if using 300 mg pre-filled pen) 1
Clinical Evidence Supporting Dosing
Long-term efficacy data from the MEASURE 3 study demonstrates that both 150 mg and 300 mg doses provide sustained improvements in ankylosing spondylitis symptoms through 3 years of treatment. At week 156, ASAS20/40 response rates were 75.0%/56.5% for 300 mg and 68.2%/47.7% for 150 mg 2.
For patients who are tumor necrosis factor inhibitor inadequate responders (TNF-IR), the 300 mg dose may provide additional benefits, particularly for more stringent clinical endpoints 2.
Monitoring and Evaluation
- Evaluate response after 16 weeks of treatment
- Consider discontinuation if no response is observed after 16 weeks 1
- For patients who respond, continue maintenance dosing as prescribed
Important Precautions
Contraindications
- Hypersensitivity to secukinumab or excipients
- Clinically important active infection 1
Key Warnings
Infections: Secukinumab may increase risk of infections
- Screen for tuberculosis before initiating therapy
- Consider anti-TB therapy in patients with latent TB
- Monitor for signs/symptoms of infection during treatment 1
Inflammatory Bowel Disease:
- Not recommended in patients with IBD
- Monitor for signs/symptoms of IBD
- Discontinue if IBD develops or worsens 1
Injection Site Reactions:
- Avoid injecting into areas of active psoriasis 1
Practical Administration Tips
- Allow medication to reach room temperature before injection (15-30 minutes)
- Inspect solution for particulate matter or discoloration
- Proper solution should be clear to slightly opalescent, colorless to slightly yellow
- Discard if solution contains visible particles or is discolored 3
The clinical evidence consistently shows that the 150 mg dose is effective for most patients with ankylosing spondylitis, with the option to increase to 300 mg for those with inadequate response. Long-term studies demonstrate sustained efficacy and safety through 3-5 years of treatment 2, 4.