What is Cosentyx (secukinumab) used for in adult patients with chronic inflammatory conditions?

What is Cosentyx (Secukinumab) Used For?

Cosentyx (secukinumab) is a fully human monoclonal antibody that selectively targets interleukin-17A (IL-17A) and is FDA-approved for treating multiple chronic inflammatory conditions including moderate to severe plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, enthesitis-related arthritis, and hidradenitis suppurativa. 1

FDA-Approved Indications

Plaque Psoriasis

• Approved for moderate to severe plaque psoriasis in patients 6 years and older who are candidates for systemic therapy or phototherapy 1
• Recommended as first-line monotherapy with Grade A evidence strength 2
• Standard dosing: 300 mg subcutaneously at weeks 0,1,2,3, and 4, then every 4 weeks thereafter 2, 1
• The 300 mg dose demonstrates superior efficacy compared to 150 mg and should be prioritized 2
• Achieves PASI 90 response in 79% of patients by week 16, outperforming ustekinumab (57.6%) 2
• Highly effective for difficult-to-treat areas including scalp, nails, and palmoplantar psoriasis 2

Psoriatic Arthritis (PsA)

• Approved for active psoriatic arthritis in patients 2 years of age and older 1
• Effective for peripheral arthritis, enthesitis, dactylitis, and inhibits radiographic progression 3
• Improves both joint symptoms and psoriatic skin manifestations simultaneously 2
• Recommended with Grade A evidence when psoriasis is associated with psoriatic arthritis 2

Ankylosing Spondylitis (AS)

• Approved for adult patients with active ankylosing spondylitis 1
• Strongly recommended over no treatment in patients with active AS 2
• Important caveat: In patients with AS and recurrent uveitis, TNF inhibitor monoclonal antibodies (adalimumab or infliximab) are preferred over secukinumab, as secukinumab was not efficacious for panuveitis or posterior uveitis 2
• Critical warning: In patients with AS and inflammatory bowel disease (IBD), TNF inhibitor monoclonal antibodies are conditionally recommended over secukinumab, as secukinumab has been associated with new onset or exacerbation of Crohn's disease 2

Non-Radiographic Axial Spondyloarthritis (nr-axSpA)

• Approved for adult patients with active nr-axSpA with objective signs of inflammation 1
• Conditionally recommended (lower strength than for AS) due to limited trial data in this specific population 2

Enthesitis-Related Arthritis (ERA)

• Approved for active enthesitis-related arthritis in pediatric patients 4 years of age and older 1

Hidradenitis Suppurativa (HS)

• Approved for adult patients with moderate to severe hidradenitis suppurativa 1
• Indicated for patients with inadequate response to conventional systemic HS therapy 4
• Dosing: 300 mg subcutaneously at weeks 0,1,2,3, and 4, then every 4 weeks; may increase to every 2 weeks if inadequate response 4

Mechanism of Action

• Secukinumab is a fully human IgG1κ monoclonal antibody that selectively binds and neutralizes IL-17A 5, 6, 7
• IL-17A is a key pro-inflammatory cytokine elevated in psoriatic lesions and plays a pivotal role in the Th17 inflammatory pathway 6, 7
• By blocking IL-17A, secukinumab interrupts the inflammatory cascade driving these chronic inflammatory conditions 2

Critical Safety Considerations and Contraindications

Absolute Contraindications

• Active inflammatory bowel disease (Crohn's disease or ulcerative colitis) - secukinumab has been associated with new onset or exacerbation of IBD 2, 4
• Active tuberculosis infection 2, 1

Pre-Treatment Requirements

• Mandatory tuberculosis screening (PPD or interferon-gamma release assay) before initiating therapy 2, 8, 4, 1
• Treat latent TB before starting secukinumab 1
• Complete all age-appropriate vaccinations per current immunization guidelines before treatment initiation 1
• Baseline complete blood count (CBC) to monitor for neutropenia 8
• Consider baseline inflammatory markers (CRP) to assess disease activity 8

Ongoing Monitoring

• Periodic CBC monitoring during maintenance therapy for neutropenia (most cases are mild, transient, and reversible) 8, 4
• Clinical monitoring for signs of infection, as secukinumab increases infection risk 8, 4
• Monitor for inflammatory bowel disease symptoms in at-risk patients 8

Common Adverse Events

• Upper respiratory tract infections (very common, ≥1/10 patients) 8, 9
• Oral herpes, headache, rhinorrhea, diarrhea, nausea, and fatigue 9, 4
• Mucosal and cutaneous candidiasis 8, 4
• Weight gain is NOT an expected side effect of secukinumab therapy 9

Serious Adverse Events

• Serious infections occur in approximately 0.015 per patient-year 8
• Rare cases of Grade 4 neutropenia have been reported 8
• Rare hypersensitivity reactions, including anaphylaxis 4

Clinical Context and Treatment Positioning

For psoriasis: Secukinumab is positioned as a highly effective first-line biologic option, demonstrating superior efficacy compared to etanercept and ustekinumab in head-to-head trials 2, 6

For psoriatic arthritis: Among biologics, TNF inhibitors have established FDA approval for prevention of joint destruction, while secukinumab effectively treats both skin and joint manifestations but does not carry this specific label 2

For axial spondyloarthritis with comorbidities: Exercise caution and consider TNF inhibitor monoclonal antibodies instead when patients have concurrent uveitis or inflammatory bowel disease 2