Introduction
Cosentyx (secukinumab) is a human monoclonal antibody biologic medication developed by Novartis Pharmaceuticals. It represents a significant advancement in the treatment of several chronic inflammatory conditions by specifically targeting interleukin-17A (IL-17A), a key proinflammatory cytokine involved in the pathogenesis of psoriasis, psoriatic arthritis, and ankylosing spondylitis. First approved by the FDA in 2015, Cosentyx has become a cornerstone therapy for patients with moderate-to-severe disease who have inadequate response to conventional treatments.
Mechanism of Action
Cosentyx exerts its therapeutic effects through highly selective inhibition of interleukin-17A (IL-17A). IL-17A is a proinflammatory cytokine produced by Th17 cells that plays a crucial role in the pathogenesis of psoriatic diseases and spondyloarthritis. By binding to IL-17A with high affinity, secukinumab prevents its interaction with the IL-17 receptor, thereby inhibiting the release of proinflammatory cytokines, chemokines, and mediators of tissue damage. This targeted mechanism disrupts the inflammatory cascade that drives disease pathology, resulting in reduced epidermal hyperplasia, decreased synovial inflammation, and improved clinical symptoms.
Indications
Cosentyx is FDA-approved for:
- Moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy
- Active psoriatic arthritis in adults
- Active ankylosing spondylitis in adults
- Active non-radiographic axial spondyloarthritis in adults with objective signs of inflammation
Dosage and Administration
Standard Dosing:- Plaque Psoriasis: 300 mg administered by subcutaneous injection at weeks 0, 1, 2, 3, and 4, followed by 300 mg every 4 weeks. For some patients, 150 mg may be acceptable.
- Psoriatic Arthritis: 150 mg with or without loading dose (150 mg at weeks 0, 1, 2, 3, and 4)
- Ankylosing Spondylitis: 150 mg with loading dose (150 mg at weeks 0, 1, 2, 3, and 4) followed by 150 mg every 4 weeks
- For subcutaneous injection only
- Pre-filled syringes or Sensoready pens
- Rotate injection sites (thighs, abdomen, upper arms)
- Allow to reach room temperature (15-30 minutes) before injection
- Hepatic impairment: No dosage adjustment required
- Renal impairment: No dosage adjustment required
- Elderly: No dosage adjustment required
- Pediatrics: Safety and effectiveness not established
Pharmacokinetics
Absorption: Bioavailability approximately 73% following subcutaneous administration Distribution: Volume of distribution ~7.1-8.6 L; binds specifically to IL-17A Metabolism: Degraded via proteolytic enzymes into small peptides and amino acids Elimination: Half-life ~22-31 days; clearance ~0.14-0.22 L/day Steady State: Achieved by week 20 with every-4-week dosingContraindications
- Hypersensitivity to secukinumab or any component of the formulation
- Patients with clinically significant active infections (e.g., tuberculosis)
Warnings and Precautions
Infections: Increased risk of serious infections; evaluate patients for TB before initiating treatment Inflammatory Bowel Disease: May exacerbate or new-onset IBD may occur; monitor patients closely Hypersensitivity Reactions: Anaphylaxis and angioedema may occur Vaccinations: Avoid live vaccines during treatment; ensure all appropriate vaccinations are current before initiation Tuberculosis: Evaluate for latent TB before initiation; treat latent TB if indicatedDrug Interactions
- Live vaccines: Avoid concurrent administration
- CYP450 substrates: Secukinumab may normalize CYP450 enzymes altered by chronic inflammation
- Other biologics: Increased risk of immunosuppression; generally not recommended
Adverse Effects
Most Common (≥1%):- Upper respiratory infections
- Nasopharyngitis
- Diarrhea
- Rhinitis
- Oral herpes
- Urticaria
- Injection site reactions
- Serious infections (including opportunistic infections)
- Inflammatory bowel disease exacerbation
- Hypersensitivity reactions
- Neutropenia
Monitoring Parameters
Baseline:- TB screening (quantiferon or PPD)
- Complete blood count with differential
- Liver function tests
- Infection screening
- Vaccination status
- Signs and symptoms of infection
- Inflammatory bowel disease symptoms
- Neutropenia (if clinically indicated)
- Clinical response assessment
- Injection site reactions
- Patient adherence
Patient Education
- Proper injection technique and site rotation
- Recognition of infection symptoms (fever, chills, cough)
- Importance of not receiving live vaccines during treatment
- Need to report new gastrointestinal symptoms promptly
- Storage requirements (refrigerate at 2-8°C; do not freeze)
- Do not stop medication without consulting healthcare provider
- Keep all scheduled follow-up appointments
- Inform all healthcare providers about Cosentyx use
References
1. Langley RG, Elewski BE, Lebwohl M, et al. Secukinumab in plaque psoriasis—results of two phase 3 trials. N Engl J Med. 2014;371(4):326-338. 2. McInnes IB, Mease PJ, Kirkham B, et al. Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2015;386(9999):1137-1146. 3. Baeten D, Sieper J, Braun J, et al. Secukinumab, an interleukin-17A inhibitor, in ankylosing spondylitis. N Engl J Med. 2015;373(26):2534-2548. 4. Cosentyx [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2022. 5. FDA prescribing information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/125504s047lbl.pdf 6. Smith JA, Colbert RA. Review: The interleukin-23/interleukin-17 axis in spondyloarthritis pathogenesis: Th17 and beyond. Arthritis Rheumatol. 2014;66(2):231-241.