What is the recommended secukinumab dosage and treatment duration for an adult with moderate-to-severe plaque psoriasis?

Secukinumab Dosing and Treatment Duration for Moderate-to-Severe Plaque Psoriasis

For adults with moderate-to-severe plaque psoriasis, administer secukinumab 300 mg subcutaneously at weeks 0,1,2,3, and 4, followed by 300 mg every 4 weeks indefinitely as maintenance therapy. 1, 2

Loading Phase (Weeks 0-4)

• Administer 300 mg subcutaneously at five consecutive weekly injections: week 0, week 1, week 2, week 3, and week 4 1, 2
• Each 300 mg dose is given as either one 300 mg injection or two 150 mg injections 1, 2
• Inject at different anatomic locations (upper arms, thighs, or any quadrant of abdomen) for each dose, avoiding areas with active psoriasis 1, 2

Maintenance Phase (Week 8 onwards)

• Continue 300 mg subcutaneously every 4 weeks starting at week 8 and continuing indefinitely 1, 2
• The 300 mg dose is superior to 150 mg and should be prioritized—79% of patients achieve PASI 90 at week 16 with 300 mg 1, 3
• Response is maintained through 52 weeks and beyond with continued every-4-week dosing 1, 4

Treatment Duration

Secukinumab is a long-term maintenance therapy without a predetermined stopping point. 1, 4, 5

• Efficacy is sustained for at least 2 years in adults and has been demonstrated up to 5 years in clinical trials 1, 5
• Consider discontinuation only if there is no response after 16 weeks of treatment 1
• Do not attempt "as-needed" dosing after the initial 12 weeks—this approach is significantly less effective than continued every-4-week maintenance 1

Dosing Modifications Based on Response

For Inadequate Responders at Week 24

• Patients weighing ≥90 kg who fail to achieve PASI 90 by week 24 may benefit from dose intensification to 300 mg every 2 weeks 5
• This intensified regimen showed numerically higher PASI 90 response (57.1% vs. 40%) in heavier patients 5

For Excellent Responders (PASI 90 at Week 24)

• Do not extend the dosing interval to every 6 weeks—this strategy failed to maintain PASI 90 response (74.9% vs. 85.7% with standard every-4-week dosing) 5
• Standard every-4-week dosing remains optimal even for patients achieving excellent early responses 5

Alternative Lower Dose (Not Recommended)

• A 150 mg dose may be acceptable for some patients, but this is inferior to 300 mg 1, 2
• At week 52, PASI 90 response with 150 mg is only 50.3% compared to 68.0% with 300 mg 4

Pre-Treatment Requirements

Before initiating secukinumab, complete the following mandatory screening: 1, 3, 2

• Tuberculosis screening: Test for active and latent TB; do not start secukinumab with active TB infection 1, 3
• Latent TB management: Initiate anti-tuberculosis therapy before starting secukinumab in patients with latent TB 1, 3
• Infection screening: Assess for active infections or sepsis; avoid initiation during active infection 3
• Hepatitis B screening: Untreated hepatitis B is a relative contraindication 3
• Inflammatory bowel disease history: Secukinumab may worsen or trigger IBD; discontinue if new-onset or exacerbation occurs 1, 3

Vaccination Strategy

• Administer all live attenuated vaccines at least 2-4 weeks before starting secukinumab 3
• Live vaccines are absolutely contraindicated once secukinumab is started 3
• Complete pneumococcal vaccine and annual influenza vaccination before or during therapy 3
• Killed vaccines can be given at any time, including after starting secukinumab 3

Self-Administration

• Secukinumab is designed for self-administration by subcutaneous injection after proper training 2, 4, 6
• Pre-filled syringes and pens demonstrate 100% successful self-administration rates with high patient acceptability 4, 6
• Adult caregivers can administer injections to pediatric patients after training 2

Safety Monitoring During Long-Term Treatment

Monitor for the following adverse events throughout treatment: 1, 3, 4

• Mucocutaneous candida infections: Occur at 1.9 per 100 patient-years but are typically mild and responsive to standard antifungal treatment 3
• Serious infections: Occur at low rates (0.015 per patient-year) but require treatment discontinuation until resolved 3
• Inflammatory bowel disease: New cases or exacerbations require immediate discontinuation of secukinumab 1, 3
• Neutropenia: Usually mild, transient, and reversible 3
• Immunogenicity: Neutralizing antibodies develop in <1% of patients and rarely affect efficacy 1, 3

Common Pitfalls to Avoid

• Do not attempt interval extension to every 6 weeks even in excellent responders—this significantly reduces efficacy 5
• Do not use "as-needed" dosing after the loading phase—continuous every-4-week dosing is essential for maintained response 1
• Do not underdose with 150 mg when 300 mg is appropriate—the higher dose is equally safe and significantly more effective 1, 4
• Do not delay treatment for killed vaccines—these can be administered concurrently or after starting therapy 3