What is secukinumab?
Secukinumab (trade name Cosentyx) is a type of biological therapy which interferes with the function of IL-17A proteins. This action modifies the immune activity and inflammation that cause the symptoms of psoriatic arthritis.
Secukinumab can be prescribed by a consultant rheumatologist for adults with psoriatic arthritis and ankylosing spondylitis. It’s a long-term treatment, so it may be up to four months before you start to notice the benefits (although some people notice an improvement in the first few weeks of treatment). It can be used alone or with methotrexate.
Secukinumab won’t be started if:
- your arthritis isn’t active
- you’re pregnant or breastfeeding
- you haven’t tried other treatments appropriate for your condition first.
Your doctor may decide not to prescribe secukinumab if:
- you have, or have recently had, an infection
- you have Crohn’s disease or ulcerative colitis
- you’re having phototherapy treatment for psoriasis.
You’ll probably have blood tests before treatment starts to assess your disease and whether the drug is suitable for you. Your doctor will need to check if you’ve previously been exposed to tuberculosis (TB), and you may need a course of treatment for latent (asymptomatic) TB before starting secukinumab.
If you’re taking other drugs alongside your secukinumab (such as methotrexate) you’ll also need to continue your blood tests for these.
How is it taken?
Secukinumab is given as an injection under the skin (subcutaneous injection). After the first dose you will be given another four at weekly intervals, and one each month from then on.
It is available in a pre-filled syringe or pen so you, your partner, or another family member can learn to give these injections at home. If you miss a dose or take one too soon, ask your rheumatology team for advice on when to take your next dose.
If you have a latex allergy you should mention this to your doctor as the needle cover on the pre-filled syringe may contain latex and could cause a reaction.
Because it’s is a long-term treatment, it’s important to keep taking secukinumab (unless you have severe side-effects):
- even if it doesn’t seem to be working at first
- even when your symptoms improve (to help keep the disease under control).
Side-effects and risks
Some side-effects can happen around the time of the injection. The most common are a runny nose or sore throat, cold sores and diarrhoea. These aren’t usually serious.
Because secukinumab affects your immune system you may be more likely to pick up infections. Tell your doctor or rheumatology nurse straight away if you develop a sore throat, fever or any other signs of infection. You should also tell your rheumatology team if you have any of symptoms of infection before having an injection. They may advise you to delay the treatment.
Some people have an allergic reaction with sudden swelling, a rash or breathlessness. This is very rare, but if you do develop these symptoms, or any other severe symptoms, during or soon after a dose of secukinumab, you should seek medical advice immediately.
Reducing the risk of infection
- Try to avoid close contact with people with active infections.
- For advice on avoiding infection from food, visit: www.nhs.uk/live-well/eat-well/10-ways-to-prevent-food-poisoning/
Effects on other treatments
You may be taking methotrexate as well as secukinumab. Check with your doctor before starting any new medicines, and remember to mention you’re on secukinumab if you’re treated by anyone other than your usual rheumatology team.
- You can carry on taking non-steroidal anti-inflammatory drugs (NSAIDs) or painkillers, if needed, unless your doctor advises otherwise.
- Don’t take over-the-counter or herbal medicines without discussing it first with your rheumatology team.
It’s recommended that you carry a biological therapy alert card, so anyone treating you will know that you’re on secukinumab – ask your rheumatology team for a card.
It’s best to discuss with your doctor any vaccines you might need before you start taking secukinumab. It’s usually recommended that people on secukinumab should avoid live vaccines such as yellow fever and shingles.
Pneumovax, which protects against the most common cause of pneumonia, and yearly flu vaccines may be recommended.
Having an operation
If you’re thinking about having an operation, talk this over with your specialists. You may be advised to stop secukinumab for a time before and after surgery.
There’s no known interaction between secukinumab and alcohol. However, if you’re also taking methotrexate, this can interact with alcohol and damage your liver so you should keep well within the recommended limits of no more than 14 units of alcohol per week for adults – unless your doctor advises a lower limit.
Fertility, pregnancy and breastfeeding
If you're thinking of trying for a baby, talk to your rheumatology team in advance so that you can plan what to do with your medication.
The latest guidelines say that women can take secukinumab while trying to become pregnant. But it's recommended that women stop taking this drug if they become pregnant.
You should be OK to breastfeed while taking secukinumab, but the research is limited so you should discuss this with your doctor.