Secukinumab is a human interleukin-17A (IL-17A) antagonist indicated for the treatment of:

• Moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy
• Adults with active psoriatic arthritis (PsA)
• Adults with active ankylosing spondylitis (AS)

Secukinumab is a human monoclonal antibody that selectively binds to and inhibits interleukin-17A (IL-17A), thereby reducing inflammation associated with psoriasis, an autoimmune dermatological condition. The exact pathophysiology of psoriasis is not fully understood; however, dysregulation of innate and adaptive immune responses plays a key role in chronic inflammation. IL-17 is a family of six pro-inflammatory cytokines (IL-17A to IL-17F) with pleiotropic effects, and their levels are increased in psoriatic skin. These cytokines act on multiple cell types and contribute to host defense against extracellular bacterial and fungal infections. IL-17 cytokines are produced by immune cells such as Th17 cells, mast cells, neutrophils, and dendritic cells, all of which contribute to inflammatory processes. Evidence suggests that IL-17 is involved in the pathogenesis of several autoimmune diseases, including rheumatoid arthritis, spondyloarthritis, psoriasis, Crohn’s disease, multiple sclerosis, and atherosclerosis.

Plaque Psoriasis:

1. Recommended dosage is 300 mg by subcutaneous injection at Weeks 0, 1, 2, 3, and 4 followed by 300 mg every 4 weeks. For some patients, a dose of 150 mg may be acceptable.

Psoriatic Arthritis:

1. For psoriatic arthritis patients with coexistent moderate to severe plaque psoriasis, use the dosage and administration for plaque psoriasis.
2. For other psoriatic arthritis patients administer with or without a loading dosage. The recommended dosage:

• With a loading dosage is 150 mg at weeks 0, 1, 2, 3, and 4 and every 4 weeks thereafter.
• Without a loading dosage is 150 mg every 4 weeks.
• If a patient continues to have active psoriatic arthritis, consider a dosage of 300 mg.

Ankylosing Spondylitis:

1. Administer with or without a loading dosage. The recommended dosage:

• With a loading dosage is 150 mg at weeks 0, 1, 2, 3, and 4 and every 4 weeks thereafter.
• Without a loading dosage is 150 mg every 4 weeks.

Live vaccines should not be administered concurrently with secukinumab.

Secukinumab is contraindicated in patients with a history of serious hypersensitivity to secukinumab or any of its excipients.

The most commonly reported adverse reactions (greater than 1%) include nasopharyngitis, diarrhea, and upper respiratory tract infection.

Pregnancy: Limited human data are available regarding secukinumab use in pregnant women, and they are insufficient to determine drug-associated risks of developmental outcomes. In animal studies, no adverse fetal effects were observed in monkeys receiving doses up to 30 times the maximum recommended human dose during organogenesis.

Lactation: It is unknown whether secukinumab is excreted in human breast milk or absorbed systemically by the infant. There are no data on its effects on the breastfed child or milk production. The benefits of breastfeeding should be weighed against the mother’s clinical need and any potential risk to the infant.

Infections: Serious infections have been reported. Caution should be used when prescribing secukinumab in patients with chronic infections or a history of recurrent infections. If a serious infection occurs, secukinumab should be discontinued until the infection is resolved.

Tuberculosis (TB): Patients should be evaluated for tuberculosis before starting secukinumab therapy.

Inflammatory Bowel Disease: Cases of inflammatory bowel disease have been reported in clinical trials. Caution is advised when prescribing secukinumab to patients with a history of inflammatory bowel disease.

Hypersensitivity Reactions: If anaphylaxis or other severe allergic reactions occur, secukinumab should be stopped immediately and appropriate treatment should be initiated.

Single intravenous doses up to 30 mg/kg have been administered without dose-limiting toxicity. In case of overdose, patients should be monitored for adverse reactions and symptomatic treatment should be given as needed.

Drugs for osteoarthritis, drugs used for rheumatoid arthritis

Secukinumab Sensoready pens, prefilled syringes, and vials should be stored in a refrigerator at 2°C–8°C. Keep in the original carton to protect from light until use. Do not freeze. Do not shake to avoid foaming. Any unused portion should be discarded as it contains no preservative.