Secukinumab
Overview
Secukinumab is a fully human monoclonal antibody that selectively binds to and neutralizes interleukin-17A (IL-17A), a pro-inflammatory cytokine involved in the pathogenesis of several chronic immune-mediated diseases. By blocking IL-17A, Secukinumab reduces inflammation, keratinocyte proliferation, and joint damage. It is administered as a subcutaneous injection and has become a key treatment for moderate to severe plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis. Its high efficacy in skin clearance and joint symptom relief, combined with a favorable safety profile, has made it one of the most widely used IL-17 inhibitors in clinical practice.
Background and Date of Approval
Secukinumab was developed by Novartis and received its first global regulatory approval in 2015 for the treatment of moderate to severe plaque psoriasis in adults. Shortly after, it gained approvals for active psoriatic arthritis and ankylosing spondylitis, supported by large-scale phase III trials such as ERASURE, FIXTURE, FUTURE, and MEASURE studies. These pivotal trials demonstrated rapid and sustained improvements in skin clearance, reduction in joint inflammation, and enhanced quality of life measures. Over time, indications expanded to include non-radiographic axial spondyloarthritis and pediatric psoriasis. Both the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have approved Secukinumab, with the drug now available in multiple countries worldwide. Its approval marked a milestone as the first IL-17A inhibitor for immune-mediated inflammatory disorders.
Uses
Secukinumab is indicated for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. It is also approved for psoriatic arthritis, either as monotherapy or in combination with methotrexate, providing both joint protection and skin clearance. In ankylosing spondylitis and non-radiographic axial spondyloarthritis, Secukinumab reduces spinal inflammation and improves mobility. Pediatric indications include plaque psoriasis in children six years and older. Its use in various immune-mediated conditions highlights its role as a targeted biologic therapy for chronic inflammatory diseases.
Administration
Secukinumab is administered via subcutaneous injection, typically starting with a loading phase of 300 mg at weeks 0, 1, 2, 3, and 4, followed by a maintenance dose of 300 mg every four weeks for plaque psoriasis. In psoriatic arthritis and ankylosing spondylitis, 150 mg is often used, with the option to increase to 300 mg based on response. Pediatric dosing is weight-based. Patients may self-administer using a prefilled syringe or auto-injector pen after proper training. Clinical monitoring includes assessment of infection risk, vaccination status, and periodic evaluation of treatment efficacy.
Side Effects
The most frequently reported side effects of Secukinumab are upper respiratory tract infections, headache, diarrhea, and nasopharyngitis. Injection site reactions such as redness, itching, and mild pain are relatively common but usually mild. Most adverse effects occur early in treatment and are self-limiting.
Warnings
Serious risks with Secukinumab include increased susceptibility to infections, particularly fungal and opportunistic infections. Cases of inflammatory bowel disease flare-ups, including Crohn’s disease and ulcerative colitis, have been reported. Hypersensitivity reactions, though rare, may occur. Patients should discontinue treatment and seek urgent care if they develop severe allergic reactions, persistent fever, or worsening gastrointestinal symptoms.
Precautions
Before starting Secukinumab, patients should be screened for tuberculosis and updated on all immunizations, as live vaccines are contraindicated during therapy. Caution is advised in patients with chronic or recurrent infections, inflammatory bowel disease, or compromised immune systems. No major drug–drug interactions have been identified, but clinicians should review concomitant medications and monitor for additive immunosuppression.
Expert Tips
Prescribers should emphasize adherence to the loading schedule, as it strongly influences long-term treatment response. Regular monitoring for infection signs and gastrointestinal symptoms is essential. Pharmacists should counsel patients on proper injection techniques, safe storage, and recognizing early signs of adverse effects. Educating patients about the chronic nature of their disease and the importance of continuous therapy can improve compliance and outcomes.