Secukinumab is a targeted therapy for psoriatic arthritis, a chronic inflammatory condition affecting joints and skin. It represents a different treatment strategy compared to older, broader immunosuppressants, aiming to alleviate the symptoms of this complex autoimmune disorder.
How Secukinumab Targets Psoriatic Arthritis
Secukinumab, marketed under the brand name Cosentyx, is a biologic medication classified as a monoclonal antibody. It specifically targets and neutralizes a protein in the body called interleukin-17A (IL-17A). IL-17A is a cytokine, a type of signaling molecule, that plays a significant role in the body’s inflammatory processes.
Elevated levels of IL-17A are found in the blood and psoriatic plaques of individuals with psoriatic arthritis. By binding directly to IL-17A, secukinumab prevents it from interacting with its receptors on various cells, thereby disrupting the inflammatory cascade.
This targeted action helps to reduce inflammation, which is a primary driver of joint damage in psoriatic arthritis. The blockade of IL-17A inhibits the production of other inflammatory mediators, such as chemokines and matrix metalloproteinases, which are involved in recruiting inflammatory cells and amplifying tissue damage.
Who Can Use Secukinumab and How It’s Given
Secukinumab is approved for adults and children two years of age and older with active psoriatic arthritis. It is used for patients whose condition has not responded adequately to other systemic therapies. The medication can be used alone or in combination with other disease-modifying antirheumatic drugs (DMARDs), such as methotrexate.
It is administered as a subcutaneous injection. For adults, the dose is 150 mg every four weeks. Some patients receive an initial “loading dose” of 150 mg injections at weeks 0, 1, 2, 3, and 4, followed by monthly maintenance. If symptoms persist, a healthcare provider may increase the dose to 300 mg every four weeks.
Before starting treatment with secukinumab, healthcare providers will conduct a thorough evaluation. This includes screening for tuberculosis (TB) infection, as secukinumab should not be given to patients with active TB. If latent TB is detected, treatment for TB should be initiated before starting secukinumab. Patients should also inform their doctor about any history of chronic or recurrent infections, inflammatory bowel disease, or hepatitis B, as these conditions require careful consideration.
What to Expect During Secukinumab Treatment
Patients undergoing secukinumab treatment for psoriatic arthritis can expect improvements across various aspects of the disease. Clinical studies have shown reduction in joint pain, swelling, and enthesitis (inflammation where tendons or ligaments attach to bone). Improvements in dactylitis (swelling of fingers or toes) and psoriatic skin plaques have also been observed. Many patients experience enhanced physical function and quality of life.
The onset of benefits can vary, but some individuals may begin to see improvements within three weeks to a year of starting treatment. Long-term studies have indicated that secukinumab can inhibit the radiographic progression of peripheral arthritis, meaning it can help slow down joint damage over time. These improvements have been sustained over extended periods, up to five years in some studies.
While generally well-tolerated, secukinumab can lead to certain side effects. Common side effects include symptoms similar to a cold, such as sore throat or runny nose, upper respiratory tract infections, and diarrhea. Injection site reactions, such as redness, rash, or swelling, are usually mild.
More serious, though less common, side effects include a heightened risk of infections, including fungal infections, and severe allergic reactions. Patients should report any signs of infection, such as fever, or persistent cough, to their healthcare provider immediately. Ongoing monitoring by a healthcare professional is important throughout the treatment course to assess effectiveness and manage any potential side effects.