NOTE: The discussion of safety / adverse effects herein focusses on key topics, and is NOT exhaustive.  Please consult the official product monograph. 

MECHANISM OF ACTION

  • Secukinumab is a human IgG1 monoclonal antibody that selectively binds to interleukin-17A (IL-17A) and inhibits its interaction with the IL-17 receptor. IL-17A is a naturally occurring cytokine involved in normal inflammatory and immune responses.

INDICATIONS

  •  Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Psoriasis (PsO)

ADULT DOSING

  • AS, PsA
    • 150 mg SC weekly at weeks 0, 1, 2, 3, and 4 followed by 150 mg every 4 weeks
    • Consider increasing to 300 mg every 4 weeks in patients who continue to have active ankylosing spondylitis
  • PsO
    • 300 mg SC weekly at weeks 0, 1, 2, 3, and 4 followed by 300 mg every 4 weeks
    • Some patients may only require 150 mg per dose

DOSE ADJUSTMENT

 Hepatic Impairment: No dose adjustments provided in product monograph

 Renal Impairment: No dose adjustments provided in product monograph

SCREENING PRIOR TO STARTING THERAPY

  • Secukinumab has NOT been shown to be associated with TB reactivation
  • However, all patients with chronic inflammatory rheumatic diseases are typically screened for latent TB and viral hepatitis prior to initiating biologic therapy and JAK inhibitors (see Screening under RheumTutoring)

VACCINATION

Patients with chronic inflammatory / rheumatic disease have an increased risk of infection.  Vaccinations should be considered at earlier ages than that prescribed for the general population.  Ideally, the following vaccines should be considered in patients prior to starting biologics, especially patients over 50.  However, depending on disease severity, one may need to proceed with biologic therapy and vaccinate along the way (most frequent scenario in clinical practice).  Data suggests reduced vaccine response (antibody titres) while on some DMARDS / Biologics, but this has not been shown to result in increased risk of infection.

  • Pneumonia: Prevnar 13, Pneumovax (given two months apart in this order).  If Pneumovax was received first, wait one year before giving Prevnar 13.
  • Shingles: Shingrix (two doses given 2-6 months apart; biologic can be started 2 weeks after the first dose).  Shingrix is preferred over the (older) live attenuated Zostavax vaccine.  If Zostavax is used, it must be given at least 2 weeks prior to starting biologics.
  • Annual flu vaccine

MONITORING

  •  Patients with rheumatic diseases on biologics are typically re-assessed clinically every 3-6 months, with investigations performed as clinically indicated.

WHEN TO AVOID

  •  Secukinumab should be avoided in patients with active infection, active malignancy, hypersensitivity to secukinumab / components.

SIDE EFFECTS AND ADVERSE REACTIONS

  • Infection: the risk of infection is considered to be very low, but a small increase in the risk of infection was noted in clinical trials, including nasopharyngitis, upper respiratory tract infection, and mucocutaneous candidiasis.  When considering therapy, this has to be balanced against the increased risk of infection caused by active rheumatic / inflammatory disease.  Risk of infection is also confounded by use of concomitant DMARDS and prednisone.  Advise patients with symptoms of infection to hold the biologic, seek medical attention,and do not resume until one week after recovery.
  • Inflammatory bowel disease: Treatment with secukinumab may cause exacerbations of IBD, and some data has suggested a low risk of new onset disease.  However, other data sets show that this risk is equal to that expected in the background spondyloarthritis population.

PREGNANCY

  • Outcome information following exposure to secukinumab in pregnancy is limited.

LACTATION

  • It is not known if secukinumab is present in breast milk.
  • According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.  In general, biologic therapy is considered to be compatible with breastfeeding.