secukinumab

Contraindicated in:

Hypersensitivity;
Acute viral hepatitis.

Use Cautiously in:

Chronic infection/history recurrent infection (including tuberculosis [TB]);
Inflammatory bowel disease (exacerbation may occur);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children <18 yr (psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and hidradenitis suppurativa) or <6 yr (plaque psoriasis).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: eczematous eruptions

GI: diarrhea, inflammatory bowel disease

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS OR ANGIOEDEMA) , INFECTION(INCLUDING HEPATITIS B VIRUS REACTIVATION)

Interactions ⬆ ⬇

Drug-drug:

↑risk of adverse reactions with live vaccines; avoid concurrent use.
Administration of non-live vaccines may not elicit antibody response sufficient to produce protection.
May affect activity of CYP450 enzymes and may alter the effectiveness/toxicity of CYP450 substrate, including warfarin and cyclosporine; close monitoring is recommended and necessary dose modifications undertaken.

Availability ⬆ ⬇

Solution for SUBQ injection (caps contain latex) (prefilled syringes): 75 mg/0.5 mL; 150 mg/mL
Solution for SUBQ injection (caps contain latex) (Sensoready pen): 150 mg/mL
Solution for SUBQ injection (UnoReady pen): 150 mg/mL
Solution for IV injection: 25 mg/mL

Route/Dosage ⬆ ⬇

Plaque Psoriasis

SC (Adults ): 300 mg once weekly for 5 wk, then 300 mg every 4 wk; for select patients, a dose of 150 mg may be sufficient.
SC (Children ≥6 yr and ≥50 kg): 150 mg once weekly for 5 wk, then 150 mg every 4 wk.
SC (Children ≥6 yr and <50 kg): 75 mg once weekly for 5 wk, then 75 mg every 4 wk.

Psoriatic Arthritis

SC (Adults ): Initiate therapy with or without a loading dose. With loading dose: 150 mg once weekly for 5 wk; then 150 mg every 4 wk; if patient continues to have symptoms, may ↑ dose to 300 mg. Without loading dose: 150 mg every 4 wk; if patient continues to have symptoms, may ↑ dose to 300 mg.
IV (Adults ): Initiate therapy with or without a loading dose. With loading dose: 6 mg/kg initially; then 1.75 mg/kg (max dose = 300 mg) every 4 wk. Without loading dose: 1.75 mg/kg (max dose = 300 mg) every 4 wk.
SC (Children ≥2 yr and ≥50 kg): 150 mg once weekly for 5 wk; then 150 mg every 4 wk.
SC (Children ≥2 yr and 15–<50 kg): 75 mg once weekly for 5 wk; then 150 mg every 4 wk.

Ankylosing Spondylitis

SC (Adults ): Initiate therapy with or without a loading dose. With loading dose: 150 mg once weekly for 5 wk; then 150 mg every 4 wk; if patient continues to have symptoms, may ↑ dose to 300 mg; Without loading dose: 150 mg every 4 wk; if patient continues to have symptoms, may ↑ dose to 300 mg.
IV (Adults ): Initiate therapy with or without a loading dose. With loading dose: 6 mg/kg initially; then 1.75 mg/kg (max dose = 300 mg) every 4 wk. Without loading dose: 1.75 mg/kg (max dose = 300 mg) every 4 wk.

Non-radiographic Axial Spondyloarthritis

SC (Adults ): Initiate therapy with or without a loading dose. With loading dose: 150 mg once weekly for 5 wk; then 150 mg every 4 wk; Without loading dose: 150 mg every 4 wk.
IV (Adults ): Initiate therapy with or without a loading dose. With loading dose: 6 mg/kg initially; then 1.75 mg/kg (max dose = 300 mg) every 4 wk. Without loading dose: 1.75 mg/kg (max dose = 300 mg) every 4 wk.

Enthesitis-Related Arthritis

SC (Adults and Children ≥4 yr and ≥50 kg): 150 mg once weekly for 5 wk; then 150 mg every 4 wk.
SC (Adults and Children ≥4 yr and 15–<50 kg): 75 mg once weekly for 5 wk; then 150 mg every 4 wk.

Hidradenitis Suppurativa

SC (Adults ): 300 mg once weekly for 5 wk; then 300 mg every 4 wk; if patient does not adequately respond, may ↑ dose to 300 mg every 2 wk.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

A monoclonal antibody that acts as an antagonist of interleukin (IL)-17A by selectively binding to it and preventing its interaction with the IL-17 receptor. Antagonism prevents the production of inflammatory cytokines and chemokines.

Therapeutic effects:

Decreased plaque formation and spread in plaque psoriasis.
Decreased progression of and decreased structural damage associated with psoriatic arthritis.
Decreased signs and symptoms in ankylosing spondylitis.
Decreased disease activity in non-radiographic axial spondyloarthritis.
Decreased risk of disease flare in juvenile psoriatic arthritis and enthesitis-related arthritis.
Reduction in abscesses and inflammatory nodules in hidradenitis suppurativa.

Classifications ⬆ ⬇

Therapeutic Classification: antipsoriatics

Pharmacologic Classification: interleukin antagonists, monoclonal antibodies

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following SUBQ administration. IV administration results in complete bioavailability.

Distribution: Levels in interstitial fluid of skin (lesional and nonlesional) are 27–40% those of serum.

Metabolism/Excretion: Catabolized into small peptides and amino acids.

Half-Life: 22–31 days.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
SUBQ	unknown	6 hr	unknown
IV	rapid	end of infusion	unknown

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of secukinumab to patient. If an appointment is missed, contact health care professional as soon as possible to reschedule. Instruct patient on the correct technique for administering secukinumab. Review Medication Guide, preparation of dose, administration sites and technique, and disposal of equipment into a puncture-resistant container. Advise patient to review Medication Guide with each Rx in case of changes.
Caution patient to notify health care professional immediately if signs of infection, severe rash, swollen face, or difficulty breathing occur while taking secukinumab.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Advise patient to avoid live vaccines during therapy.
Instruct patient to notify health care professional of medication regimen prior to treatment or surgery.
Sensoready Pen and UnoReady Pen: Adults may self-administer, if appropriate. Pediatric patients should not self-administer; a caregiver should inject pen. Use the UnoReady or Sensoready pen within 5 min of removing the cap. Allow refrigerated product to return to room temperature before administering. Clean area for injection with alcohol swab. Hold pen with cap pointing up. Check solution through window; if discolored, cloudy, or contains flakes, discard solution. Remove cap. Place pen, with window visible, against skin at a 90° angle and press button until 2 clicks are heard. 1st click indicates injection started; 2nd click indicates injection is almost complete. Hold pen in place until all solution is injected (10 sec) and green marker is visible in window and has filled window. Remove needle and press with a gauze pad or cotton ball for 10 sec. Do not rub injection site. Dispose of pen into a puncture-resistant container.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇