Is Cosentyx (secukinumab) safe to use during pregnancy?

Is Cosentyx (Secukinumab) Safe in Pregnancy?

Cosentyx should be discontinued when pregnancy is confirmed, as it is not recommended for use during pregnancy. 1

Key Recommendation

The American College of Rheumatology conditionally recommends stopping secukinumab once pregnancy is confirmed. 1 This applies to women with rheumatic and musculoskeletal diseases including psoriatic arthritis, ankylosing spondylitis, and related conditions.

Manufacturer's Position

The drug label explicitly states that Cosentyx use should preferably be avoided during pregnancy. 1 Women of childbearing potential must use effective contraception during treatment and for at least 20 weeks after the last dose. 1

Clinical Context and Rationale

Why Discontinue at Pregnancy Confirmation?

• Secukinumab is an IgG monoclonal antibody that crosses the placenta, particularly after 20 weeks of gestation 1
• Limited human pregnancy data exists to establish safety, making it a "preferably avoid" medication 1
• The conditional recommendation reflects insufficient evidence rather than proven harm, but caution is warranted 1

Timing Considerations

• Periconception exposure (before pregnancy is confirmed) carries relatively lower risk since IgG antibodies don't cross the placenta significantly in the first trimester 1
• Discontinuation should occur immediately upon pregnancy confirmation to minimize fetal exposure 1
• The 20-week washout period after stopping treatment is recommended before attempting conception 1

Alternative Approaches for Disease Control

Safer Biologic Options During Pregnancy

If biologic therapy is essential for disease control during pregnancy:

• Certolizumab pegol is the preferred biologic as it does not cross the placenta and can be continued throughout pregnancy 2
• Other TNF-α inhibitors (infliximab, adalimumab, etanercept, golimumab) can be conditionally continued, though they cross the placenta after 20 weeks 1, 2
• IL-17 inhibitors like secukinumab should be stopped, along with other agents like ustekinumab, rituximab, belimumab, and abatacept 1

Treatment Strategy

The priority is maintaining disease remission during pregnancy rather than the specific agent used. 1 If secukinumab must be discontinued:

• Switch to pregnancy-compatible medications before conception when possible 1
• Consider certolizumab or other TNF inhibitors if biologic therapy remains necessary 2
• Conventional immunosuppressants like azathioprine, cyclosporine, and tacrolimus can be continued conditionally 1

Important Caveats

Inadvertent Exposure

If pregnancy occurs while on secukinumab:

• Do not panic - first trimester exposure carries lower risk due to minimal placental transfer 1
• Discontinue immediately upon pregnancy confirmation 1
• Counsel the patient about the limited data and unknown risks 1
• Document the exposure and consider enrollment in pregnancy registries if available 2

Breastfeeding

Secukinumab is conditionally compatible with breastfeeding. 1 Large monoclonal antibodies have minimal transfer into breast milk and poor oral bioavailability in infants. 1 The decision should balance the benefit of breastfeeding against the benefit of continuing therapy, with consideration to discontinue up to 20 weeks after the last dose. 1

Disease Activity Considerations

Uncontrolled inflammatory disease poses its own risks to pregnancy outcomes, including preterm birth and intrauterine growth restriction. 1 The goal is achieving remission before conception and maintaining it throughout pregnancy with the safest effective medications. 1

Contraception Requirements

Effective contraception is mandatory during secukinumab treatment and for at least 20 weeks after discontinuation. 1 This extended period accounts for the drug's elimination half-life and ensures minimal fetal exposure if conception occurs.