Routine Bloodwork Recommendations for Patients on Cosentyx (Secukinumab)
No specific routine bloodwork monitoring is mandated for patients on Cosentyx (secukinumab), but monitoring for neutropenia and infections is recommended due to potential adverse effects reported in clinical use. 1
Recommended Monitoring
Before Initiating Treatment
- Tuberculosis screening - Test for latent TB before starting therapy 1
- Baseline complete blood count (CBC) - To monitor for potential neutropenia which has been reported with secukinumab 1
- Inflammatory markers - Consider baseline C-reactive protein (CRP) to assess disease activity 1
During Treatment
- Complete blood count (CBC) - Monitor periodically for neutropenia, which occurs more frequently with secukinumab than placebo 1
- Signs of infection - No specific laboratory test required, but clinical monitoring for infections is essential as secukinumab increases infection risk 1
- Inflammatory bowel disease markers - Consider monitoring in patients with risk factors for IBD as secukinumab has been associated with new cases or exacerbations of inflammatory bowel disease 1
Frequency of Monitoring
While no strict monitoring schedule is mandated in the prescribing information:
- Baseline tests before initiating therapy 1, 2
- Periodic monitoring (every 3-6 months) during maintenance therapy 1
- Symptom-driven testing if signs of infection or neutropenia develop 1
Important Considerations
Neutropenia Monitoring
- Neutropenia occurs more frequently with secukinumab than placebo 1
- Most cases are mild, transient, and reversible 1
- Rare cases of Grade 4 neutropenia have been reported 1
Infection Surveillance
- Upper respiratory tract infections are very common (≥1/10) 1
- Mucosal and cutaneous candidiasis (including oral and esophageal) have been reported 1
- Serious infections occur in a small proportion of patients (0.015 serious infections per patient-year) 1
No Routine Liver or Kidney Function Monitoring Required
- Unlike some other biologics, secukinumab does not have specific requirements for liver or kidney function monitoring 1
- However, baseline assessment of organ function may be prudent as part of comprehensive care 2
Common Pitfalls to Avoid
- Overlooking TB screening - Secukinumab should not be given to patients with active TB; consider anti-TB therapy before starting in patients with latent TB 1
- Ignoring signs of IBD - Secukinumab is not recommended in patients with inflammatory bowel disease and should be discontinued if signs/symptoms develop 1
- Missing neutropenia - Although most cases are mild, monitoring CBC periodically can help identify this potential adverse effect 1
- Failing to recognize infections - Particularly candidiasis, which occurs more frequently with secukinumab 1