Secukinumab

Generic Name: Secukinumab

Brand Names: Cosentyx

Secukinumab is an IL-17A inhibitor biologic for psoriasis, psoriatic arthritis, and ankylosing spondylitis.

DermatologicRheumatologicBiologic

Drug Class

Interleukin-17A (IL-17A) Inhibitor (Biologic / Monoclonal Antibody)

Pregnancy

No adequate human data. Animal reproduction studies at doses up to 30 times the maximum recommended human dose revealed no evidence of harm to the fetus. However, use during pregnancy only if clearly needed. Encourage enrollment in pregnancy registries if exposure occurs.

Available Forms

150 mg/mL prefilled syringe, 150 mg/mL prefilled pen (Sensoready), 150 mg lyophilized powder for reconstitution (for healthcare provider use)

What It's Used For

Dosage Quick Reference

These are general dosage guidelines. Your doctor will determine the appropriate dose for your specific situation.

Condition	Starting Dose	Maintenance Dose
Plaque Psoriasis (adults)	300 mg SC at weeks 0, 1, 2, 3, and 4	300 mg SC every 4 weeks; some patients may use 150 mg
Psoriatic Arthritis	150 mg SC at weeks 0, 1, 2, 3, and 4 (with loading dose); or 150 mg without loading	150 mg SC every 4 weeks; may increase to 300 mg if inadequate response
Ankylosing Spondylitis	150 mg SC at weeks 0, 1, 2, 3, and 4 (with loading dose); or 150 mg without loading	150 mg SC every 4 weeks; may increase to 300 mg if inadequate response

Side Effects

Common Side Effects:

Nasopharyngitis
Diarrhea
Upper respiratory tract infection
Rhinitis
Oral herpes
Pharyngitis
Urticaria

Serious Side Effects:

Serious infections
Inflammatory bowel disease (new onset or exacerbation)
Hypersensitivity reactions (anaphylaxis)
Neutropenia

Drug Interactions

Live vaccines: Avoid live or live-attenuated vaccines during secukinumab therapy. Immunosuppression may increase the risk of infection from the vaccine organism. Complete all age-appropriate vaccinations before initiating treatment if possible.
CYP450 substrates with narrow therapeutic index (warfarin, cyclosporine, theophylline): IL-17A can affect CYP450 enzyme expression. When secukinumab is started or stopped, monitor levels or effects of concomitant CYP450 substrate medications, especially warfarin (monitor INR) and cyclosporine (monitor levels).
Other biologic immunosuppressants (adalimumab, infliximab, etanercept, ustekinumab): Concurrent biologic therapy is not recommended due to increased infection risk without demonstrated additive benefit.
Immunosuppressive agents (methotrexate, cyclosporine, azathioprine): Commonly used in combination, especially methotrexate for psoriatic arthritis, but increased infection surveillance is warranted.

Additional Information

Secukinumab is a human monoclonal antibody that selectively binds to interleukin-17A (IL-17A), neutralizing its activity. It is used to treat moderate-to-severe plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis.

Mechanism of Action

Secukinumab targets the IL-17A cytokine pathway:

IL-17A neutralization: Binds to IL-17A with high affinity and specificity
Blocks receptor binding: Prevents IL-17A from interacting with IL-17 receptor
Reduces inflammation: IL-17A promotes keratinocyte proliferation and recruitment of inflammatory cells
Decreases downstream mediators: Reduces chemokines, cytokines, and tissue-damaging molecules

IL-17A is overexpressed in psoriatic skin lesions and inflamed joints.

Available Formulations

Secukinumab is available as:

Prefilled syringe: 75 mg/0.5 mL, 150 mg/mL
Prefilled pen (Sensoready): 150 mg/mL, 300 mg/2 mL
Lyophilized powder: 150 mg vial (for reconstitution)

Medical Uses

FDA-Approved Indications:

Moderate-to-severe plaque psoriasis in adults and pediatric patients ≥6 years
Active psoriatic arthritis in adults
Active ankylosing spondylitis in adults
Active non-radiographic axial spondyloarthritis with objective signs of inflammation
Active enthesitis-related arthritis in patients ≥4 years

Dosing Guidelines

Plaque Psoriasis (Adults):

Induction: 300 mg at weeks 0, 1, 2, 3, and 4
Maintenance: 300 mg every 4 weeks
Some patients may use 150 mg

Psoriatic Arthritis:

With coexistent psoriasis: 300 mg at weeks 0, 1, 2, 3, 4, then every 4 weeks
Without coexistent psoriasis: 150 mg at weeks 0, 1, 2, 3, 4, then every 4 weeks; may increase to 300 mg
With TNF inhibitor: May use loading dose or start with maintenance dosing

Ankylosing Spondylitis / nr-axSpA:

With loading: 150 mg at weeks 0, 1, 2, 3, 4, then every 4 weeks
Without loading: 150 mg every 4 weeks
May increase to 300 mg for AS

Important Safety Information

Contraindications:

Previous serious hypersensitivity reaction to secukinumab

Warnings and Precautions:

Infections: Increased risk; evaluate for TB before initiating
Tuberculosis: Test for latent TB; treat before starting
Inflammatory bowel disease: New onset or exacerbations reported; use with caution if history of IBD
Hypersensitivity reactions: Anaphylaxis and urticaria reported
Latex sensitivity: Needle cap of prefilled syringe contains latex

Drug Interactions

No formal drug interaction studies conducted. IL-17A inhibition may reverse cytokine-mediated suppression of CYP450 enzymes.

Considerations:

Live vaccines: Avoid during treatment
CYP450 substrates with narrow therapeutic index (e.g., warfarin, cyclosporine): Monitor when initiating or discontinuing secukinumab

Special Populations

Hepatic Impairment: Not specifically studied
Renal Impairment: Not expected to affect pharmacokinetics
Pregnancy: Limited data; use only if benefit outweighs risk
Lactation: Unknown if excreted in milk
Pediatric: Approved for plaque psoriasis ≥6 years; enthesitis-related arthritis ≥4 years
Elderly: No dose adjustment

Frequently Asked Questions

In clinical trials, approximately 70-80% of patients with moderate-to-severe plaque psoriasis achieved at least a 75% improvement in their PASI score (PASI 75) by week 16. Many patients experienced clear or almost-clear skin. Results vary by individual.

Yes. Cases of new-onset or exacerbation of Crohn disease and ulcerative colitis have been reported with IL-17A inhibitors including secukinumab. If you have a history of inflammatory bowel disease, your doctor should carefully weigh the risks and benefits. Notify your doctor if you develop new or worsening GI symptoms such as diarrhea, abdominal pain, or bloody stools.

Yes. As with other biologic therapies, TB screening (typically a tuberculin skin test or interferon-gamma release assay) is recommended before initiating secukinumab. If latent TB is detected, treatment for TB should be initiated before starting secukinumab.

Secukinumab prefilled syringes and pens should be refrigerated at 36-46 degrees F (2-8 degrees C). Do not freeze. They can be kept at room temperature (up to 77 degrees F / 25 degrees C) for up to 4 days. Protect from light by keeping in the original carton until time of use.

Yes, after the initial loading doses (which may be done in a clinical setting), many patients self-inject at home using the prefilled syringe or Sensoready pen. Your healthcare provider or nurse will train you on proper injection technique, site rotation, and disposal of sharps.

Questions to Ask Your Doctor

Consider discussing these topics at your next appointment:

✓Have I been screened for tuberculosis, hepatitis B, and hepatitis C before starting secukinumab?
✓Do I have any history of inflammatory bowel disease that could be worsened by this medication?
✓Should I receive any vaccinations before initiating secukinumab therapy?
✓How long should I try secukinumab before we decide whether it is working well enough?

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Related Health Conditions

This medication is commonly used to treat or manage the following conditions:

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Ulcerative Colitis

Ulcerative colitis is a chronic inflammatory bowel disease causing ulcers and inflammation in the colon and rectum, driven by immune dysfunction, genetics, and environmental factors, leading to symptoms like diarrhea and abdominal pain.

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Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.