Secukinumab

 

What is Secukinumab?

Secukinumab is a targeted disease modifying anti-rheumatic drug (DMARD) that is used to reduce inflammation produced by the body. In certain diseases the immune system is over active, this can target healthy tissues such as joints and the skin. Secukinumab works on the inflammatory pathway to block a protein called IL-17a, thereby reducing the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints.

 

What is Secukinumab used for?

Secukinumab is used for the treatments of psoriasis, psoriatic arthritis and ankylosing spondylitis.

 

How is it taken?

Secukinumab is given as an injection into the layer of fat between the skin and muscle. This is called a subcutaneous injection and is usually given into the thigh or abdomen. It can be given alone or in combination with other DMARDs such as methotrexate.

The injection device is available as a prefilled syringe or pen. It should be stored in the fridge at home.

 

The injections are given initially as loading doses at 150mg at week 0, 1, 2, 3 and 4 followed by a 150mg injection every 4 weeks thereafter. In certain cases of psoriatic arthritis, the dose may be increased to 300mg (2 150mg injections).

 

It can take up to 12 weeks to have a full effect. You will be seen in clinic at around this point to see how you are getting along.

 

When you first start taking it you will need your bloods monitored. This is done at 3 months and if they are satisfactory, they are then just needed annually. If you are taking other DMARDs that require blood monitoring this should be continued.

 

If your symptoms are very well controlled on secukinumab, the dose can be reduced. Increasing the time between injections does this.

 

Side effects

There are a few possible side effects that can occur in a small number of people that take secukinumab, these include:

 

• Sore throat, stuffy nose and headaches
  • These usually settle after taking the medication for a few weeks.
• Increased risk of infections
  • As secukinumab dampens the immune system, you can be more prone to infection. You should be seen by your GP if you feel unwell in case you need antibiotics. You must temporarily stop your injections whilst you are unwell and receiving treatment, they can be started up again when you feel well.
  • You should try to avoid contact with others that have chicken pox or shingles.
• Subcutaneous injection site reactions
  • Irritation, rashes and blistering can occur.
  • Mild steroid creams and antihistamines can be used to settle things down. If these don’t work, then you should see your GP.
• Diarrhoea
  • Rarely secukinumab can cause diarrhoea, you should try to stay well hydrated and if it is persistent, contact your GP.
  • Very rarely taking secukinumab can reveal a new diagnosis of inflammatory bowel disease. Secukinumab should not be taken in this case.

 

Cautions of use

Interactions with other medications

• Your doctor will check if there are any medications that could interact.
• You can carry on taking your usual painkillers including NSAIDs.

Contraindications of other conditions

• Before starting any biological therapy, your bloods will be checked for infections that can become active again when the immune system is suppressed, this includes hepatitis B, C and HIV. A blood and chest X-ray is taken to exclude previous TB exposure. If you are found to have had previous TB exposure you may need to start preventative antibiotics for a short period before the secukinumab is commenced.
• If you have a history of inflammatory bowel disease, secukinumab is not suitable to use as it can provoke a flare up of symptoms.
• Secukinumab is not safe to be used if you are being investigated for or have been diagnosed with cancer.

Operations

• Secukinumab should be withheld for 1 week after the last dose would have been due. Therefore surgery can be scheduled for week 5.

During pregnancy and breastfeeding

• There is very little data on secukinumab in pregnancy or breastfeeding. Therefore it should not be used.
• If you are considering starting a family, secukinumab should be stopped at least 5 months before trying to conceive.
• There is no data on the use in males who are trying to conceive.

Alcohol

• Alcohol and secukinumab do not interact, however it is recommended to take alcohol within moderation, following the guidelines of less than 14 units weekly.

Vaccinations

• Flu and the pneumonia vaccine are safe and recommended whilst taking secukinumab.
• Live vaccines including the shingles vaccine should not be given due to the dampening down of the immune system.

 

Useful Links

Versus Arthritis: http://www.versusarthritis.org