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 who require systemic treatment. This was followed in 2016 by an extension of the indication for psoriatic arthritis and ankylosing spondylitis (Bekhterev's disease).

Since 31.07.2020 also approved for children and adolescents 6-18 years!

Secukinumab has proven 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 secukinumab or placebo subcutaneously in weeks 1, 2, 3, 4 and 8. At week 12, 81.6 percent (300 mg) and 71.6 percent (150 mg) of secukinumab patients met the PASI-75 criteria, while only 4.5 percent of control patients did. 65.3 vs. 51.2 vs. 2.4% of participants were clinically largely appearance-free, > 40% of study participants achieved PASI-100 (complete clinical freedom from 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 also maintained during this 5-year observation period.

Secukinumab is now also approved for moderate to severe hidradenitis suppurativa (^Cosentyx® product information).

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).

1. Adami S (2014) The Role of Interleukin-17A in Psoriatic Disease. BioDrugs 28:487-497
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.
8. Chiricozzi A (2014) Pathogenic role of IL-17 in psoriasis and psoriatic arthritis. Actas Dermosifiliogr 105 Suppl 1:9-20
9. Galluzzo M et al. (2019) Biologic therapy for acrodermatitis continua of Hallopeau: Successful treatment with secukinumab and review of the literature. Dermatol Ther 32:e12899.

10. Kimball AB et al (2023) Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): week 16 and week 52 results of two identical, multicentre, randomized, placebo-controlled, double-blind phase 3 trials. Lancet 401(10378):747-761.

11. Lønnberg AS et al. (2014) Targeting of interleukin-17 in the treatment of psoriasis. Clin Cosmet Invest Dermatol 15:251-259

12. 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
13. Paul C et al. (2014) the JUNCTURE study group. Efficacy, safety and usability of secukinumab administration by autoinjector/pen in psoriasis: a randomized, controlled trial (JUNCTURE). J Eur Acad Dermatol Venereol doi:10.1111/jdv.12751.
14. Sobell JM et al. (2014) Therapeutic development in psoriasis. Semin Cutan Med Surg 33 (4 Suppl): 69-72