Secukinumab

How it works

It binds and neutralises interleukin-17A, a key pro-inflammatory cytokine of the Th17 pathway involved in the joint and skin inflammation of spondyloarthritides and psoriasis.

Prescribing in practice

• Screen for and treat latent tuberculosis and exclude active infection before starting, as with other biologics.
• Use with caution in inflammatory bowel disease because IL-17 inhibition can trigger new onset or exacerbations of Crohn's disease and ulcerative colitis.
• Candida and other mucocutaneous infections are more frequent, and live vaccines should be avoided during treatment.

Monitoring

Monitor clinically for infection, for new or worsening inflammatory bowel symptoms, and for treatment response throughout therapy.

Counselling the patient

• Report signs of infection, including persistent oral or genital thrush.
• Tell us about any new or worsening abdominal pain or diarrhoea.
• It is a subcutaneous injection that can be self-administered after training.

Evidence & guidelines

Its rheumatology indications are supported by randomised controlled trials demonstrating improved joint, spinal and skin outcomes in spondyloarthritis and psoriatic arthritis.