SECUKINUMAB

By Gary M. White, MD

Note: This is a summary only. Please consult the latest information when prescribing.


Indication

Warnings and Precautions

Vaccines

Live vaccines should not be given with Cosentyx. Prior to initiating therapy consider completion of all age appropriate immunizations. Patients may receive killed vaccines. However non-live vaccines given during the course of Cosentyx may not elicit an immune response sufficient to prevent disease.

Trade name

Cosentyx

Mechanism of Action

Blocks IL-17

Europe

The European Commission has approved secukinumab as a first-line systemic treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy.

Dosing for and Use in Psoriasis

Side Effects

Concern with infection as with other TNF agents is noted. Candida infection has been noted at higher frequencies than placebo. Cases however seem to be mucocutaneous, mild and not systemic. Patients should be monitored for any signs of tuberculosis. New onset or exacerbation of IBD has been noted. Patients with Crohn's disease may want to avoid Cosentyx as patients with CD treated with secukinumab tended to have greater disease activity and increased adverse events.

Secukinumab has been reported to induce a psoriasiform eruption of the fingertips and nails. A 61-year-old woman with psoriasis cleared after 2 months of secukinumab, but 1 month later, developed severe, disabling fingernail dystrophy and distal onychopathy. Stopping the secukinumab and starting ustekinumab and topical methotrexate cleared the eruption [JAMA Derm 20-17;153;1194]. Of note, secukinumab has been used successfully to treat acrodermatitis continua of Hallopeau [JAMA Derm 2017;153;336].

Pregnancy Category B

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