secukinumab (Rx)

Brand and Other Names:Cosentyx
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

lyophilized powder for reconstitution

  • 150mg/vial

solution for injection

  • 150mg/prefilled syringe
  • 150mg/Sensoready pen

Moderate-to-Severe Plaque or Scalp Psoriasis

Candidates for systemic therapy or phototherapy

Initial: 300 mg SC at weeks 0, 1, 2, 3, and 4

Monthly maintenance: Beginning at week 8, give 300 mg SC once monthly

For some patients, a dose of 150 mg may be acceptable

Active Psoriatic Arthritis

With coexistent moderate-to-severe plaque psoriasis, use the dosing and administration recommendations for plaque psoriasis

Recommended dosage

  • For other patients with psoriatic arthritis, administer with or without a loading dosage by SC injection
  • With loading dose: 150 mg SC at weeks 0, 1, 2, 3, and 4 and q4wk thereafter
  • Without loading dose: 150 mg SC q4wk
  • If a patient continues to have active psoriatic arthritis, consider a dosage of 300 mg
  • May be administered with or without methotrexate

Ankylosing Spondylitis

Indicated for adults with active ankylosing spondylitis

Administer with or without a loading dosage by SC injection

With loading dose: 150 mg SC at weeks 0, 1, 2, 3, and 4 and q4wk thereafter

Without a loading dose: 150 mg SC q4wk

If a patient continues to have active ankylosing spondylitis, consider increasing dose to 300 mg q4wk

Non-radiographic Axial Spondyloarthritis

Indicated for active non-radiographic axial spondyloarthritis with objective signs of inflammation

Administer with or without loading dose

With loading dose: 150 mg SC at Weeks 0, 1, 2, 3, and 4, THEN q4Weeks thereafter

Without loading dose: 150 mg SC q4Weeks

Dosage Modifications

Renal or hepatic impairment

  • Studies have not been conducted to assess effect on pharmacokinetics

Dosing Considerations

Evaluate patients for tuberculosis infection prior to initiating treatment

Dosage Forms & Strengths

lyophilized powder for reconstitution

  • 150mg/vial

solution for injection

  • 75mg/prefilled syringe
  • 150mg/prefilled syringe
  • 150mg/Sensoready pen

Plaque Psoriasis

Indicated for moderate-to-severe plaque psoriasis in patients aged ≥6 years who are candidates for systemic therapy or phototherapy

<6 years

  • Safety and efficacy not established

≥6 years

  • <50 kg: 75 mg SC at weeks 0, 1, 2, 3, and 4 followed by 75 mg SC q4week
  • ≥50 kg: 150 mg SC at weeks 0, 1, 2, 3, and 4 followed by 150 mg SC q4week

Dosage Modifications

Renal or hepatic impairment

  • Studies have not been conducted to assess effect on pharmacokinetics

Dosing Considerations

Evaluate patients for tuberculosis infection prior to initiating treatment

Complete all age-appropriate vaccinations as recommended by current immunization guidelines before initiating

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Interactions

Interaction Checker

and secukinumab

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      Serious - Use Alternative

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            Contraindicated (13)

            • adenovirus types 4 and 7 live, oral

              secukinumab decreases effects of adenovirus types 4 and 7 live, oral by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • BCG vaccine live

              secukinumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • influenza virus vaccine quadrivalent, intranasal

              secukinumab decreases effects of influenza virus vaccine quadrivalent, intranasal by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • measles (rubeola) vaccine

              secukinumab decreases effects of measles (rubeola) vaccine by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • measles mumps and rubella vaccine, live

              secukinumab decreases effects of measles mumps and rubella vaccine, live by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • measles, mumps, rubella and varicella vaccine, live

              secukinumab decreases effects of measles, mumps, rubella and varicella vaccine, live by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • rotavirus oral vaccine, live

              secukinumab decreases effects of rotavirus oral vaccine, live by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • smallpox (vaccinia) vaccine, live

              secukinumab decreases effects of smallpox (vaccinia) vaccine, live by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • typhoid polysaccharide vaccine

              secukinumab decreases effects of typhoid polysaccharide vaccine by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • typhoid vaccine live

              secukinumab decreases effects of typhoid vaccine live by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • varicella virus vaccine live

              secukinumab decreases effects of varicella virus vaccine live by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • yellow fever vaccine

              secukinumab decreases effects of yellow fever vaccine by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            • zoster vaccine live

              secukinumab decreases effects of zoster vaccine live by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.

            Serious - Use Alternative (27)

            • anthrax vaccine adsorbed

              secukinumab decreases effects of anthrax vaccine adsorbed by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • diphtheria & tetanus toxoids

              secukinumab decreases effects of diphtheria & tetanus toxoids by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • diphtheria & tetanus toxoids/ acellular pertussis vaccine

              secukinumab decreases effects of diphtheria & tetanus toxoids/ acellular pertussis vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine

              secukinumab decreases effects of diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • hepatitis A vaccine inactivated

              secukinumab decreases effects of hepatitis A vaccine inactivated by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • hepatitis a/b vaccine

              secukinumab decreases effects of hepatitis a/b vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • hepatitis b vaccine

              secukinumab decreases effects of hepatitis b vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • human papillomavirus vaccine, nonavalent

              secukinumab decreases effects of human papillomavirus vaccine, nonavalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • human papillomavirus vaccine, quadrivalent

              secukinumab decreases effects of human papillomavirus vaccine, quadrivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • influenza A (H5N1) vaccine

              secukinumab decreases effects of influenza A (H5N1) vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • influenza virus vaccine (H5N1), adjuvanted

              secukinumab decreases effects of influenza virus vaccine (H5N1), adjuvanted by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • influenza virus vaccine quadrivalent

              secukinumab decreases effects of influenza virus vaccine quadrivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • influenza virus vaccine quadrivalent, cell-cultured

              secukinumab decreases effects of influenza virus vaccine quadrivalent, cell-cultured by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • influenza virus vaccine quadrivalent, recombinant

              secukinumab decreases effects of influenza virus vaccine quadrivalent, recombinant by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • influenza virus vaccine trivalent

              secukinumab decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • influenza virus vaccine trivalent, recombinant

              secukinumab decreases effects of influenza virus vaccine trivalent, recombinant by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • Japanese encephalitis virus vaccine

              secukinumab decreases effects of Japanese encephalitis virus vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • meningococcal A C Y and W-135 diphtheria conjugate vaccine

              secukinumab decreases effects of meningococcal A C Y and W-135 diphtheria conjugate vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • meningococcal A C Y and W-135 polysaccharide vaccine combined

              secukinumab decreases effects of meningococcal A C Y and W-135 polysaccharide vaccine combined by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • meningococcal group B vaccine

              secukinumab decreases effects of meningococcal group B vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • pneumococcal vaccine 13-valent

              secukinumab decreases effects of pneumococcal vaccine 13-valent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • pneumococcal vaccine polyvalent

              secukinumab decreases effects of pneumococcal vaccine polyvalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • poliovirus vaccine inactivated

              secukinumab decreases effects of poliovirus vaccine inactivated by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

            • rabies vaccine

              secukinumab decreases effects of rabies vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • rabies vaccine chick embryo cell derived

              secukinumab decreases effects of rabies vaccine chick embryo cell derived by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine

              secukinumab decreases effects of tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            • tetanus toxoid adsorbed or fluid

              secukinumab decreases effects of tetanus toxoid adsorbed or fluid by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

            Monitor Closely (25)

            • carbamazepine

              secukinumab, carbamazepine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • clonidine

              secukinumab, clonidine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • cyclosporine

              secukinumab, cyclosporine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • dengue vaccine

              secukinumab decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

            • disopyramide

              secukinumab, disopyramide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • ethosuximide

              secukinumab, ethosuximide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • fosphenytoin

              secukinumab, fosphenytoin. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • haemophilus influenzae type b vaccine

              secukinumab decreases effects of haemophilus influenzae type b vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued if immune competence has been restored. .

            • isavuconazonium sulfate

              secukinumab and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.

            • lomustine

              lomustine and secukinumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

            • mechlorethamine

              mechlorethamine, secukinumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

            • ofatumumab SC

              ofatumumab SC, secukinumab. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

            • phenobarbital

              secukinumab, phenobarbital. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • phenytoin

              secukinumab, phenytoin. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • primidone

              secukinumab, primidone. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • quinidine

              secukinumab, quinidine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • quinine

              secukinumab, quinine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • sirolimus

              secukinumab, sirolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • tacrolimus

              secukinumab, tacrolimus. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • theophylline

              secukinumab, theophylline. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • trastuzumab

              trastuzumab, secukinumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

            • trastuzumab deruxtecan

              trastuzumab deruxtecan, secukinumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

            • valproic acid

              secukinumab, valproic acid. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • warfarin

              secukinumab, warfarin. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

            • zoster vaccine recombinant

              secukinumab decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.

            Minor (0)

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              Adverse Effects

              >10%

              Infections (28.7%)

              Nasopharyngitis (11.4-12.3%)

              1-10%

              Diarrhea (2.6-4.1%)

              URT infection (2.5-3.2%)

              Rhinitis (1.4%)

              Oral herpes (0.1-1.3%)

              Pharyngitis (1-1.2%)

              Urticaria (0.6-1.2%)

              Rhinorrhea (0.3-1.2%)

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              Warnings

              Contraindications

              Hypersensitivity

              Cautions

              May increase risk of infections; caution when considering use in patients with chronic infection or a history of recurrent infection

              In the postmarketing setting, serious and some fatal infections reported; instruct patients to seek medical advice if signs or symptoms suggestive of an infection occur; if a patient develops a serious infection, monitor the patient closely and discontinue therapy until infection resolves

              Evaluate patients for tuberculosis (TB) infection before initiating; do not administer with active TB; for latent TB, initiate anti-TB therapy prior to initiation of secukinumab in patients with a history of latent or active TB in whom an adequate course of treatment cannot be confirmed; monitor patients closely for signs and symptoms of active TB during and after treatment

              May exacerbate Crohn disease

              Anaphylaxis and cases of urticaria reported; if this occurs, discontinue secukinumab immediately and initiate anaphylaxis treatment

              Caution if latex allergic; the removable cap on the Sensoready pen and prefilled syringe contains natural rubber

              Use caution when prescribing drug to patients with inflammatory bowel disease; exacerbations, in some cases serious, reported in clinical trials in plaque psoriasis, psoriatic arthritis, ankylosing spondylitis and non-radiographic axial spondyloarthritis

              Drug interaction overview

              • Immunizations
                • Prior to initiating therapy, consider completion of all age-appropriate immunizations according to current immunization guidelines
                • Patients treated with secukinumab should not receive live vaccines
                • Nonlive vaccines received during a course of secukinumab may not elicit an immune response sufficient to prevent disease
                • Therapy may alter a patient`s immune response to live vaccines; avoid use of live vaccines in patients receiving treatment
              • CYP450 substrates
                • CYP450 enzymes are suppressed by increased levels of cytokines (eg, IL-1, IL-6, IL-10, TNF-alpha) during chronic inflammation
                • Results from a drug-drug interaction study in patients with moderate-to-severe psoriasis showed no clinically relevant interaction for drugs metabolized by CYP3A4.
                • Upon initiation or discontinuation of secukinumab in patients taking CYP450 substrates with narrow therapeutic indices, consider monitoring for therapeutic effect or drug concentration; adjust dose as needed
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              Pregnancy & Lactation

              Pregnancy

              Limited available human data regarding use in pregnant women are insufficient to inform a drug associated risk of adverse developmental outcomes

              Animal data

              • No adverse developmental effects were observed in infants born to pregnant monkeys after SC administration of secukinumab during organogenesis at doses up to 30 times the maximum recommended human dose (MRHD)

              Lactation

              Unknown if excreted in human milk or absorbed systemically after ingestion; data are unavailable regarding effects on breastfed children or milk production

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Human IgG1 monoclonal antibody that selectively binds to and neutralizes the proinflammatory cytokine interleukin 17A (IL-17A)

              IL-17A is a naturally occurring cytokine that is involved in normal inflammatory and immune responses and plays a key role in the pathogenesis of plaque psoriasis

              Absorption

              Peak plasma time: 6 days (single dose); 31-34 days (weekly dosing during first month)

              Peak plasma concentration (single dose, day 6): 13.7 mcg/mL (150 mg) and 27.3 mcg/mL (300 mg)

              Steady-state: By 24 weeks with monthly dosing

              Steady-state trough levels: 16.7 mcg/mL (150 mg) to 34.4 mcg/mL (300 mg)

              At the 300-mg dose at week 4 and week 12, the mean trough concentrations resulting from the Sensoready pen were 23-30% higher than those from the lyophilized powder and 23-26% higher than those from the prefilled syringe based on cross-study comparisons

              Distribution

              Vd: Low; 7.1-8.6 L (IV administration)

              Concentrations in interstitial fluid in lesional and nonlesional skin: 27-40% of those in serum at weeks 1 and 2

              Metabolism

              Expected to be metabolized in the same manner as any endogenous IgG via intracellular catabolism, following fluid phase or receptor-mediated endocytosis and degraded into small peptides and amino acids

              Elimination

              Half-life: 22-31 days

              Systemic clearance: Slow; 0.14-0.22 L/day

              Clearance and distribution increases with body weight

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              Administration

              SC Preparation

              Lyophilized powder for injection

              • Prepared and reconstitute with sterile water for injection (SWI) by a trained healthcare provider using aseptic technique and without interruption
              • The preparation time from piercing the stopper until end of reconstitution on average takes 20 minutes and should not exceed 90 minutes
              • Prepare the required number of vials (1 vial for the 150-mg dose or 2 vials for the 300-mg dose)
              • Remove vial and SWI from refrigerator for 15-30 minutes to reach room temperature
              • Slowly inject 1 mL of SWI into the vial and direct the stream of SWI into the lyophilized powder
              • Tilt the vial at an angle of approximately 45 degrees and gently rotate between the fingertips for approximately 1 minute
              • Do not shake or invert the vial
              • Allow the vial to stand for ~10 minutes at room temperature to allow for dissolution
              • Note that foaming may occur
              • Once again, tilt the vial at an angle of approximately 45 degrees and gently rotate between the fingertips for approximately 1 minute; do not shake or invert the vial
              • Allow the vial to stand undisturbed at room temperature for ~5 minutes
              • Reconstituted solution contains 150 mg/mL
              • The reconstituted solution should be essentially free of visible particles, clear to opalescent, and colorless to slightly yellow
              • Do not use if the lyophilized powder has not fully dissolved or if the liquid contains visible particles, is cloudy, or is discolored

              Sensoready pen and prefilled syringe

              • Before injection, remove Sensoready pen or prefilled syringe from the refrigerator and allow reach room temperature (15-30 minutes) without removing the needle cap
              • The removable cap of the Sensoready pen and the prefilled syringe contains natural rubber latex and should not be handled by latex-sensitive individuals
              • Inspect visually for particulate matter and discoloration prior to administration
              • Solution should be clear to slightly opalescent, colorless to slightly yellow solution
              • Do not use if the liquid contains visible particles, is discolored, or is cloudy
              • Does not contain preservatives; therefore, administer the Sensoready pen or prefilled syringe within 1 hr after removal from the refrigerator
              • Discard any unused product

              SC Administration

              Patient self-administration

              • Patients may self-inject after proper training in SC injection technique using the Sensoready pen or prefilled syringe and when deemed appropriate
              • Rotate administration site between the thighs or any quadrant of abdomen (or upper, outer arm if administered by a caregiver)
              • Do not inject into areas where the skin is tender, bruised, erythematous, indurated, or affected by psoriasis

              Administration by healthcare professional

              • The lyophilized powder for reconstitution is for healthcare provider use only
              • Administer each injection at a different anatomic location (eg, upper arms, thighs, or any quadrant of abdomen) from the previous injection, and not into areas where the skin is tender, bruised, erythematous, indurated, or affected by psoriasis

              Storage

              Store vials, Sensoready pens, and prefilled pens refrigerated at 2-8ºC (36-46ºF)

              Keep in the original carton to protect from light until the time of use

              Do not freeze

              To avoid foaming, do not shake

              Does not contain a preservative; discard any unused portion

              Reconstituted vial

              • After reconstitution, use the solution immediately or store in the refrigerator at 2-8ºC (36-46ºF) for up to 24 hr
              • Do not freeze
              • Allow to reach room temperature (15-30 minutes) before administration
              • Does not contain preservatives; therefore, administer within 1 hr after removal from refrigerator
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              Patient Handout

              Patient Education
              secukinumab subcutaneous

              SECUKINUMAB - INJECTION

              (SEK-ue-KIN-ue-mab)

              COMMON BRAND NAME(S): Cosentyx

              USES: This medication is used to treat plaque psoriasis and certain types of arthritis (such as arthritis of the spine, psoriatic arthritis, axial spondyloarthritis). Secukinumab belongs to a class of drugs known as monoclonal antibodies. It works by blocking a certain natural protein in your body (interleukin-17A) that may cause inflammation and swelling.

              HOW TO USE: Read the Medication Guide and the Instructions for Use leaflet provided by your pharmacist before you start using secukinumab and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Before treatment with this medication, your doctor will make sure that you have received all your vaccinations and also test you for tuberculosis (TB). Your doctor should monitor you for symptoms of TB during and after treatment with this drug. If needed, treatment for tuberculosis or other infections should be given before receiving this medication.This medication is given by injection under your skin as directed by your doctor. The injection is given in the upper arms, thighs, or abdomen (at least 2 inches from your belly button). The dosage is based on your medical condition and response to treatment. For children, the dosage is also based on their weight. Follow your doctor's instructions carefully.If you are using this medication at home, learn all preparation and usage instructions from your health care professional and the product instructions. Wash your hands before using this medication. Remove the medication from the refrigerator 15 to 30 minutes before you inject it to allow it to reach room temperature. Do not shake the medication. The medication should be clear or slightly yellow. Before using, check this product visually for cloudiness, particles, or discoloration. If you see any of these things, do not use the liquid. Before injecting each dose, clean the injection site with rubbing alcohol. Change the injection site each time to lessen injury under the skin. Do not inject the drug into areas of the skin with scars or stretch marks or into skin that is irritated, sore, bruised, red, hardened, or affected by psoriasis. To lessen bruising, do not rub the injection site after a shot. Learn how to store and discard medical supplies safely. Do not reuse syringes.Use this medication regularly to get the most benefit from it. It may help to mark your calendar with a reminder.Tell your doctor if your condition does not improve or if it worsens.

              SIDE EFFECTS: Diarrhea may occur. If this effect persists or worsens, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may lower your ability to fight infections. This may make you more likely to get a serious infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection (such as fever, chills, persistent sore throat, white patches in the mouth, cough).Tell your doctor right away if you have any serious side effects, including: stomach/abdominal pain, diarrhea with blood/mucus.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using secukinumab, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as latex found in the needle cover on the prefilled syringe/pen), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: current/recent/returning infection (such as tuberculosis, herpes), bowel disease (such as Crohn's disease, ulcerative colitis).Secukinumab can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as complete blood count) may be performed periodically to monitor your progress or to check for side effects. Consult your doctor for more details.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Store in the refrigerator. Do not freeze. Keep the product in the original carton to protect from light until the time of use. Some forms of this medication may be kept at room temperature for up to 4 days. Check the product package to see if that applies to your product. Otherwise, the medication should be used within 1 hour after taking it out of the refrigerator. Discard any unused portion after use.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.