Introduction

Secukinumab (trade name: Cosentyx) has been approved in Germany since 2015 for the systemic treatment of moderate to severe plaque psoriasis or psoriatic arthritis in adults.

It is an option for:

  • Adults who are able to have systemic treatment and/or phototherapy. This includes adults who can't have or who did not benefit enough from systemic treatment with fumaric acid esters, ciclosporin or methotrexate.
  • Adults with active psoriatic arthritis who did not benefit enough from antirheumatic medication. In this case, secukinumab is used in monotherapy or in combination with methotrexate.

Psoriasis is a non-contagious inflammatory skin disease. The symptoms usually include clearly defined red patches (called "plaques"), scaly skin and itching. Psoriasis is a chronic (long-lasting) condition for which there is currently no known cure. It comes and goes in bouts (flare-ups): The skin can suddenly get worse, but it may also get better on its own.

The most common form, affecting about 85% of people with psoriasis, is called plaque psoriasis or psoriasis vulgaris. Psoriatic arthritis (arthritis psoriatica) is less common. It also involves swelling, inflammation and pain in various joints.

Psoriasis is usually treated topically using creams or ointments. Treatment with UV radiation (phototherapy) is an option for people with severe psoriasis. There are also drugs designed to slow down or stop the inflammatory process in different ways. These drugs are taken as tablets or injected into the bloodstream. This form of treatment is called systemic treatment.

Secukinumab is intended to decrease the inflammatory reaction in the skin by inhibiting a protein to reduce the production of several chemical messengers that promote inflammation.

Application

Secukinumab is available in ready-to-use pens at a dose of 150 mg.

For plaque psoriasis, 300 mg of the drug are injected under the skin once a week during the first four weeks of therapy, and then once a month.

In psoriatic arthritis, 150 mg of the drug are injected once a week during the first four weeks of therapy, and then once a month. If the patient also has moderate to severe plaque psoriasis, or if TNFα antagonists (see below) are not effective enough, the dose can be raised to 300 mg. For psoriatic arthritis, secukinumab is used on its own or in combination with methotrexate.

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 moderate to severe plaque psoriasis who are able to have systemic therapy, the drugs fumaric acid ester, ciclosporin, or methotrexate are available in addition to phototherapy.

For people who did not benefit from systemic treatment with these drugs or who cannot take them because they are not suitable, treatment with a tumor necrosis factor (TNF) α inhibitor (adalimumab or infliximab) or the drug ustekinumab are options.

For patients with psoriatic arthritis who did not benefit enough from a therapy with antirheumatic medication, treatment with a tumor necrosis factor (TNF) α inhibitor (adalimumab, etanercept, golimumab or infliximab) is an option as well. This treatment can also be combined with methotrexate.

Assessment

In 2017, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into which advantages and disadvantages secukinumab has for adults with psoriasis compared to standard treatments.

The manufacturer did not provide any relevant data on people with active psoriatic arthritis who did not benefit enough from, or who did not tolerate, antirheumatic medication. As a result, it was not possible to determine the advantages or disadvantages of secukinumab compared with the standard treatment for this group.

For two groups of patients the manufacturer provided suitable data.

  • Adults who are able to have systemic treatment and/or phototherapy.
  • Adults who cannot have, or who did not benefit enough from, systemic treatment with fumaric acid esters, ciclosporin or methotrexate.

Learn more

More information

This information summarizes the main results of reviews produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The reviews were 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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