Introduction

Secukinumab (trade name: Cosentyx) has been approved in Germany since November 2015 for the treatment of ankylosing spondylitis (also known as Bekhtherev's disease). The drug is an option for people who did not benefit enough from a conventional therapy.

Ankylosing spondylitis is a chronic inflammatory disease that mostly affects the spine. It is classified as a rheumatic condition. Common symptoms of ankylosing spondylitis include pain in the lower back, and sometimes in the neck or the hips. The condition comes and goes in bouts or “flare-ups”: Symptoms can get worse suddenly and then get better again on their own.

The joints of the spine are inflamed, including the sacroiliac joint (the joint between the sacral bone and the iliac bone of the pelvis) and the joints between ribs and vertebrae. Because of this they may stiffen and impair the mobility of the back. Sometimes the spine will contort, causing a hunched back. When the condition advances, ribcage mobility and with it breathing can also be affected.

Conventional treatment of ankylosing spondylitis depends on the symptoms and the severity of the condition. Physiotherapy and physical activity can help maintain flexibility. Pain killers can be used for the pain. Drugs designed to slow down or stop the inflammatory process in different ways are also available.

Secukinumab is intended to decrease the inflammatory reaction in the joints by inhibiting a protein, thereby reducing the production of several chemical messengers that promote inflammation.

Application

Secukinumab is available as a pre-filled pen containing 150 mg. 150 mg of the drug are injected under the skin once a week during the first four weeks of therapy, and then once a month.

The success of the treatment needs to be monitored regularly. If there is no improvement after 16 weeks, stopping the treatment is usually recommended.

Other treatments

For people with active ankylosing spondylitis who did not benefit enough from conventional therapy, the standard therapy is treatment with a tumor necrosis factor (TNF) α antagonist (adalimumab, etanercept, golimumab, or infliximab).

Assessment

In 2016, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of secukinumab compared with the standard therapies for people with ankylosing spondylitis.

But the manufacturer did not provide any suitable data with which to answer this question. So it is not possible to determine whether secukinumab provides any added benefits in comparison with standard therapies if a conventional therapy was not effective enough.

More information

This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of these reviews and the hearings received, the G-BA passed a resolution on the added benefit of secukinumab (Cosentyx).

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