Secukinumab Treatment Protocol for Moderate-to-Severe Plaque Psoriasis
Pre-Treatment Screening Requirements
Before initiating secukinumab, screen for active tuberculosis, active infections or sepsis, untreated hepatitis B, and assess for history of inflammatory bowel disease. 1
- Screen for active tuberculosis and consider anti-tuberculosis therapy before starting secukinumab in patients with latent TB 2
- Do not initiate during active infection; if active infection or sepsis is present, consult infectious disease specialists before starting therapy 1
- Untreated hepatitis B infection is a relative contraindication 1
- Assess for inflammatory bowel disease history, as secukinumab may increase the risk of new-onset or exacerbation of Crohn's disease or ulcerative colitis 2, 1
- Complete indicated vaccinations before starting therapy 3
Dosing Protocol
Administer secukinumab 300 mg subcutaneously at weeks 0,1,2,3, and 4 (loading phase), followed by 300 mg every 4 weeks starting at week 8 (maintenance phase). 2, 1, 4
- The 300 mg dose is given as two injections of 150 mg or one injection using the 300 mg/2 mL UnoReady pen 2, 4
- Self-administration by subcutaneous injection is the standard route 1, 5
- Avoid injecting into areas of skin showing active psoriasis 2
- The 300 mg dose is more effective than 150 mg and should be prioritized 1
Special Dosing Considerations for Body Weight
For patients with body weight ≥90 kg who do not achieve adequate response, consider increasing maintenance dosing frequency to 300 mg every 2 weeks. 2, 6
- Standard every 4-week dosing maintains PASI 90 response in 85.7% of patients at week 52 6
- Patients weighing ≥90 kg not achieving PASI 90 at week 24 may benefit from every 2-week dosing (57.1% vs 40% PASI 90 response) 6
Response Assessment Timeline
Assess treatment response at week 16; if no response is achieved, consider discontinuation. 2
- At week 16, expect 79% of patients to achieve PASI 90 with 300 mg secukinumab 1
- Response is maintained through 52 weeks and beyond with continued dosing 1
- Consider discontinuation if no response after 16 weeks of treatment 2
Monitoring During Treatment
Monitor for mucocutaneous candida infections, which occur at 1.9 per 100 patient-years but are typically mild and responsive to standard antifungal treatment. 1
- Most infections are non-serious, mild-to-moderate upper respiratory tract infections (e.g., nasopharyngitis) that do not require treatment discontinuation 2
- Serious infections occur at low rates (0.015 per patient-year) but require treatment discontinuation until resolved 2, 1
- Monitor patients with serious infection closely and do not administer secukinumab until the infection resolves 2
- Neutropenia may occur but is usually mild, transient, and reversible 2
- Watch for signs of inflammatory bowel disease; if new-onset or exacerbation occurs, discontinue secukinumab 2
Combination Therapy Considerations
Secukinumab is recommended as monotherapy; combination with topical corticosteroids or vitamin D analogues may be considered, though published safety data on combinations is limited. 2, 1
- Combination with high-potency topical corticosteroids with or without vitamin D analogues can augment efficacy 2
- No evidence supports combining secukinumab with other biologics, and such combinations carry unknown risks 1
Immunogenicity
- Less than 1% of patients develop antibodies to secukinumab up to 52 weeks of treatment 2
- Treatment-emergent anti-drug antibodies occur in less than 0.5% of patients 7
Dosing Interval Adjustments
Maintain standard every 4-week dosing for optimal disease control; extending to every 6-week dosing results in inferior response rates. 6
- Every 6-week dosing maintained PASI 90 in only 74.9% vs 85.7% with every 4-week dosing at week 52 6
- Retreatment-as-needed regimens are inferior to fixed-interval maintenance dosing 7