Cosentyx (Secukinumab) and Cancer Risk
Cosentyx (secukinumab) is not believed to increase the risk of cancer based on current clinical evidence and safety data. 1, 2
Evidence on Cancer Risk with Secukinumab
Safety Profile and Malignancy Data
Secukinumab has been extensively studied with safety data from multiple clinical trials and post-marketing surveillance:
In a large integrated safety analysis with up to 5 years of follow-up across 49 clinical trials (including 10,685 psoriasis patients, 2,523 PsA patients, and 1,311 AS patients), the exposure-adjusted incidence rate (EAIR) of malignancy was only 0.85 per 100 patient treatment-years 2
The observed vs. expected number of malignancies from secukinumab clinical trial data were comparable, with a standardized incidence ratio (SIR) of 0.99 (95% CI 0.82-1.19) across indications 2
In the MEASURE 2 study for ankylosing spondylitis, the exposure-adjusted incidence rate for malignant or unspecified tumors was only 0.6 per 100 patient-years (95% CI 0.2-1.4) over 5 years of treatment 3
Post-marketing surveillance data showed an even lower estimated crude cumulative incidence reporting rate of 0.27 per 100 patient-years for malignancy across all indications 2
Use in Patients with History of Cancer
Recent evidence specifically examining secukinumab in patients with prior malignancy is reassuring:
In a 2024 study of 22 patients with spondyloarthritis and a history of malignancy treated with secukinumab, no cases of cancer relapse or progression were recorded over a median follow-up of 30 months 4
Clinical guidelines for hidradenitis suppurativa suggest that secukinumab can be considered in patients with a history of malignancy in the last 5 years based on currently available evidence 1
Comparison with Other Biologics
When considering cancer risk among different biologics:
Secukinumab (IL-17 inhibitor) is classified as a moderate risk (1-10%) agent for hepatitis B reactivation, which is different from cancer risk but reflects its immunomodulatory profile 1
For patients with inflammatory bowel disease and prior cancer, studies show no increased risk of subsequent cancer with ustekinumab (IL-12/23 inhibitor) compared to no immunosuppression 1, 5
Guidelines for psoriasis management state there is no definitive evidence that ustekinumab used as monotherapy increases the risk of solid tumor or lymphoreticular malignancy 1
Clinical Implications and Monitoring
When using Cosentyx in clinical practice:
Regular monitoring is recommended as with any biologic therapy, including periodic history and physical examination with screening for nonmelanoma skin cancer 1
For patients with a history of malignancy, consultation with the patient's oncologist is advised, taking into account the activity of the inflammatory disease, patient's age, characteristics of the previous cancer, time since completion of cancer treatment, and individual carcinogenic effects of immunosuppressants 1
The decision to use secukinumab in patients with prior malignancy should involve shared therapeutic decision-making, respecting patient preferences 1
Common Pitfalls and Caveats
- Don't confuse the risk of infection (which is a known side effect of Cosentyx) with cancer risk
- The most common adverse events with Cosentyx are upper respiratory tract infections, oral herpes, headache, rhinorrhea, diarrhea, nausea, and fatigue 1
- Patients should be screened for tuberculosis prior to initiating therapy, as this is a standard precaution with biologics 1
- Inflammatory bowel disease can be exacerbated by secukinumab, but this is unrelated to cancer risk 1
In conclusion, current evidence does not support the belief that Cosentyx increases cancer risk, with long-term safety data showing malignancy rates comparable to the general population.