Secukinumab

Secukinumab is a biologic medicine and a fully human monoclonal antibody that selectively blocks interleukin-17A (IL-17A), a protein involved in inflammation. By inhibiting this signalling pathway, secukinumab helps reduce inflammatory activity associated with certain immune-mediated diseases affecting the skin, joints and spine. It belongs to the class of IL-17 inhibitors and is used when a healthcare professional determines that targeted treatment is appropriate. Depending on the indication, formulation and local product approval, secukinumab may be administered by subcutaneous injection or intravenous infusion. It is used in conditions including plaque psoriasis, psoriatic arthritis and axial spondyloarthritis, with additional approved uses varying by country and patient age. Treatment selection depends on the diagnosis, disease severity, previous therapies, other medical conditions and risk of infection. Because secukinumab modifies immune responses, patients require assessment for tuberculosis and other relevant infections before treatment and monitoring during therapy. It may also cause or worsen inflammatory bowel disease in susceptible patients. The dose and maintenance schedule differ by condition and individual clinical response. Secukinumab should be prescribed and monitored by a qualified healthcare professional, and patients should not change or discontinue treatment without discussing it with their treating clinician.

Secukinumab was developed as a targeted biologic therapy for inflammatory diseases driven partly by interleukin-17A. It received its initial approval from the United States Food and Drug Administration (FDA) in 2015 for plaque psoriasis. The European Commission granted marketing authorisation for Cosentyx in the European Union in January 2015. Subsequent approvals expanded its use to include psoriatic arthritis, ankylosing spondylitis and non-radiographic axial spondyloarthritis, with additional indications for hidradenitis suppurativa and certain paediatric inflammatory conditions in relevant jurisdictions.

Clinical development included studies evaluating skin clearance in plaque psoriasis, joint symptoms and physical function in psoriatic arthritis, and disease activity in axial spondyloarthritis. Later clinical programmes assessed additional inflammatory conditions and age groups. Regulatory indications, approved age ranges, formulations and dosing recommendations differ between countries and may change as new evidence is reviewed. In September 2026, the European Medicines Agency's Committee for Medicinal Products for Human Use adopted a positive opinion recommending an additional indication for polymyalgia rheumatica; this recommendation should be distinguished from final marketing authorisation. Prescribers should consult the current local prescribing information before selecting treatment.

Secukinumab is used to treat moderate to severe plaque psoriasis in eligible adults and children, depending on the jurisdiction and product label. By blocking IL-17A, it can reduce inflammatory skin lesions, scaling and redness. Treatment is generally considered when systemic therapy or phototherapy is appropriate.

It is indicated for active psoriatic arthritis in eligible patients, either alone or with methotrexate where permitted by the local label. It may help reduce joint inflammation, improve symptoms and address associated skin disease. Secukinumab is also used for ankylosing spondylitis and non-radiographic axial spondyloarthritis in eligible adults, particularly when conventional treatment has not provided adequate control.

In some jurisdictions, secukinumab is approved for active moderate to severe hidradenitis suppurativa in adults who have not responded adequately to conventional systemic treatment. Certain regions also approve its use for juvenile psoriatic arthritis and enthesitis-related arthritis in children meeting specified age and treatment criteria. Other indications may be added as regulatory decisions evolve. The approved indication, patient age, disease activity requirements and previous-treatment criteria must be verified against the applicable local product information.

Secukinumab dosing depends on the condition being treated, the patient's age and weight, the formulation used and the local prescribing information. Many indications use an initial subcutaneous loading schedule at weeks 0, 1, 2, 3 and 4, followed by maintenance injections every four weeks. However, not every indication requires a loading schedule, and some patients may need a different maintenance dose or interval based on their response and the approved label.

For plaque psoriasis, the dose may differ according to age and body weight. Patients with psoriatic arthritis may receive treatment with or without a loading schedule, while some patients with coexisting moderate to severe plaque psoriasis may require the psoriasis dosing regimen. Hidradenitis suppurativa may require a different maintenance schedule, including more frequent administration for selected patients when authorised. Intravenous formulations are available for certain indications in some jurisdictions and use weight-based or indication-specific dosing.

Subcutaneous injections may be administered by trained patients or caregivers when the prescribed device and local instructions permit. Healthcare professionals should explain injection technique, storage, handling and disposal of sharps. Before treatment, clinicians should assess infection history and screen for tuberculosis. During treatment, they should review symptom control, adverse effects, adherence and the need for ongoing therapy. Patients should not alter the dose, shorten the interval or stop treatment without consulting their prescriber.

Common side effects of secukinumab include upper respiratory tract infections, such as nasopharyngitis, as well as a runny or blocked nose and diarrhoea. Some patients may experience headache, nausea or other mild gastrointestinal symptoms. Injection-site reactions, including redness, discomfort or swelling, can occur with subcutaneous administration.

The frequency and severity of adverse effects may vary by indication, dose, age and individual susceptibility. Patients should tell their healthcare professional about persistent, worsening or troublesome symptoms. Symptoms suggestive of infection, including fever, persistent cough or unusual fatigue, should be reported promptly, particularly when they do not improve or become more severe. Clinicians should evaluate whether symptoms are related to treatment and determine whether further assessment or a change in therapy is needed.

Secukinumab can increase susceptibility to infections because it alters immune signalling. Serious infections have been reported, and treatment should not be initiated in patients with an active clinically important infection until it has been adequately managed. If a serious infection develops during treatment, clinicians should assess the patient promptly and consider withholding therapy until the infection resolves.

Tuberculosis screening is required before starting treatment. Patients with latent tuberculosis or a history suggesting possible infection require appropriate evaluation and management in accordance with local guidance.

New or worsening inflammatory bowel disease, including Crohn's disease and ulcerative colitis, has been reported. Secukinumab should be used cautiously in patients with inflammatory bowel disease, and new persistent diarrhoea, abdominal pain or blood in the stool warrants medical assessment. Severe hypersensitivity reactions, including anaphylaxis, are possible. Treatment should be discontinued and urgent medical care provided if a serious allergic reaction occurs.

Patients should seek urgent medical attention for breathing difficulty, swelling of the face or throat, severe abdominal symptoms, or signs of a serious infection. The treating clinician should assess the risks and benefits of continued treatment when significant adverse events arise.

Before prescribing secukinumab, clinicians should review the patient's history of recurrent or chronic infections, tuberculosis exposure, inflammatory bowel disease, allergies and previous biologic treatments. Screening and preventive measures should follow the applicable prescribing information and clinical guidance. Patients should report any new infection symptoms and avoid starting treatment during a significant active infection unless specifically directed by their treating clinician.

Live vaccines should generally be avoided during treatment because the immune response may be altered and there may be a risk associated with live vaccine exposure. Vaccination status should be reviewed before therapy begins, and required immunisations should be planned with a healthcare professional. Non-live vaccines may be considered according to clinical guidance, although the immune response can vary.

Concurrent use with other biologic immunomodulators may increase the risk of infection or other immune-related complications and should be evaluated carefully. Medication reviews should include prescription medicines, over-the-counter products and other biologic therapies. Patients with a history of inflammatory bowel disease should be monitored for new or worsening gastrointestinal symptoms. Pregnancy, breastfeeding and plans for conception should be discussed with the treating clinician because treatment decisions depend on the individual's circumstances and available evidence.

Confirm the exact indication, age eligibility, formulation and local approval before prescribing secukinumab. Dosing schedules are not interchangeable across plaque psoriasis, psoriatic arthritis, axial spondyloarthritis and hidradenitis suppurativa. Check the current product information whenever initiating treatment or adjusting a regimen.

Complete appropriate infection assessment, including tuberculosis screening, before the first dose. Review vaccination history and discuss the avoidance of live vaccines during treatment. Ask about recurrent infections and previous or current inflammatory bowel disease, and establish a plan for evaluating concerning symptoms.

Explain the expected treatment schedule and the importance of adherence. Patients using a subcutaneous device should receive practical instruction on administration, storage and safe sharps disposal. Monitor clinical response using measures relevant to the treated condition, such as skin involvement, joint symptoms, mobility, pain and functional status. Reassess treatment when there is inadequate response, loss of effect or a significant adverse event.

Pharmacists should check for duplicate biologic therapy, confirm that the prescribed strength and device match the intended dose, and reinforce instructions for missed doses according to the product information. Document adverse reactions and coordinate with the prescriber when infection, hypersensitivity or possible inflammatory bowel disease is suspected. Regional product information should be reviewed periodically because approved indications and safety guidance may change.