Secukinumab

Secukinumab is a fully humanized monoclonal antibody against the cytokine IL-17A (see interleukins below), which is overexpressed in the pathogenesis of psoriatic inflammation (see psoriasis below) and plays a central role (see Th17 cell). The active ingredient is used in the treatment of various rheumatological diseases - also in psoriatic arthritis. The antibody secukinumab (AIN457) selectively binds to IL-17 and neutralises this cytokine.

Secukinumab was approved by the European Medicines Agency (EMA) in January 2015 for the primary systemic treatment of moderate to severe plaque psoriasis in adult patients requiring systemic treatment. This was followed in 2016 by an indication extension for psoriatic arthritis and ankylosing spondylitis (ankylosing spondylitis).

Also approved for children and adolescents 6-18 years since 07/31/2020!

Secukinumab has been shown to be successful in the treatment of psoriasis in several large studies. In the ERASURE1 study, 738 patients with moderate-to-severe psoriasis received either 300 or 150 mg of secukinumab or placebo subcutaneously at weeks 1, 2, 3, 4 and 8. At week 12, 81.6 percent (300 mg) and 71.6 percent (150 mg) of secukinumab patients, respectively, but only 4.5 percent of control patients met PASI-75 criteria. 65.3 vs. 51.2 vs. 2.4% of participants were largely free of clinical appearance, and > 40% of study participants achieved PASI-100 (complete clinical absence of appearance). The effect of secukinumab reached a maximum after 16 weeks and remained constant until week 52.

A follow-up study (A2304E1) to the pivotal SCULPTURE study, which covered a treatment period of 260 weeks, demonstrated that the initial response rate (69% PASI-90 response) was maintained over this 5-year observation period.

Several publications have described positive results in acrodermatitis continua suppurativa (Galluzzo M et al. (2019).

Side effects observed with Secukinumab include nasopharyngitis, upper respiratory tract infections and headaches. Also herpes simplex labialis, oral candidiasis, urticarial exanthema, dyslipidemia (increase in cholesterol/triglycerides) and headaches. In rare cases (1-2% of patients) a (transient) neutropenia may occur (Altenburg A et al. 2018).

The recommended dose is 300 mg as a subcutaneous injection. The 300 mg dose can be administered as two injections of 150 mg each; meanwhile, the 300 mg unit is also available. After the first dose, additional weekly injections are initially given at weeks 1, 2, and 3, with injections at monthly intervals beginning at week 4. The total injected dose is always divided into 2 single doses of 150 mg.

In children: < 50 kg body weight 75 mg; >= 50 kg body weight 150 mg subcuan at week 0-1-2-3-4 and monthly thereafter.

Cosentyx®

Secukinumab has been approved for the treatment of psoriasis under the trade name ^Cosentyx® by Novartis since mid-2015.

Good therapeutic successes have been described for psoriasis capitis (which is very difficult to treat topically) (Bagel J et al. 2017)

Recently, successful treatment with secukinumab was described for the rare SAM syndrome(severe dermatitis, multiple allergies and metabolic wasting) (Cao Q et al. 2023).

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2. Altenburg A et al. (2018) Biological side effects in psoriasis. Dermatologist 69: 290-297
3. Bagel J et al. (2017) The effect of secukinumab on moderate-to-severe scalp psoriasis: Results of a
4. 24-week, randomized, double-blind, placebo-controlled phase 3b study. J Am Acad Dermatol 77:667-674.
5. Blauvelt A et al. (2014) the FEATURE Study Group. Secukinumab administration by pre-filled syringe: efficacy, safety and usability results from a randomized controlled trial in psoriasis (FEATURE). Br J Dermatol 172: 484-492.
6. Böhner A et al. (2016) Acute Generalized Pustular Psoriasis Treated With the IL-17A Antibody Secukinumab. JAMA Dermatol 152:482-484.
7. Cao Q et al. (2023) Successful Treatment of SAM Syndrome With Secukinumab Monotherapy: A Case Report of a 16-Month-Old Infant. Dermatitis. doi: 10.1089/derm.2023.0222.
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11. Ohtsuki M et al. (2014) ERASURE Study Japanese subgroup. Secukinumab efficacy and safety in Japanese patients with moderate-to-severe plaque psoriasis: Subanalysis from ERASURE, a randomized, placebo-controlled, phase 3 study. J Dermatol 41:1039-1046
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