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Secukinumab: Pediatric drug information

Secukinumab: Pediatric drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Secukinumab: Drug information" and "Secukinumab: Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Cosentyx;
  • Cosentyx (300 MG Dose);
  • Cosentyx Sensoready (300 MG);
  • Cosentyx Sensoready Pen;
  • Cosentyx UnoReady
Brand Names: Canada
  • Cosentyx
Therapeutic Category
  • Anti-interleukin 17A Monoclonal Antibody;
  • Antipsoriatic Agent;
  • Monoclonal Antibody
Dosing: Pediatric

Dosage guidance:

Safety: Prior to initiation of secukinumab, ensure all age-appropriate vaccines are up to date.

Enthesitis-related arthritis, active

Enthesitis-related arthritis, active:

Children ≥4 years and Adolescents:

15 to <50 kg: SUBQ: 75 mg once weekly at weeks 0, 1, 2, 3, and 4, followed by 75 mg every 4 weeks.

≥50 kg: SUBQ: 150 mg once weekly at weeks 0, 1, 2, 3, and 4, followed by 150 mg every 4 weeks.

Plaque psoriasis, moderate to severe

Plaque psoriasis, moderate to severe:

Children ≥6 years and Adolescents <18 years:

15 to <50 kg: SUBQ: 75 mg once weekly at weeks 0, 1, 2, 3, and 4, followed by 75 mg every 4 weeks (Ref).

≥50 kg: SUBQ: 150 mg once weekly at weeks 0, 1, 2, 3, and 4, followed by 150 mg every 4 weeks (Ref); some may require higher dose of 300 mg every 4 weeks (Ref).

Adolescents ≥18 years: SUBQ: 300 mg once weekly at weeks 0, 1, 2, 3, and 4, followed by 300 mg every 4 weeks. Some patients may only require 150 mg/dose (Ref).

Psoriatic arthritis

Psoriatic arthritis:

Children ≥2 years and Adolescents <18 years:

15 to <50 kg: SUBQ: 75 mg once weekly at weeks 0, 1, 2, 3, and 4, followed by 75 mg every 4 weeks.

≥50 kg: SUBQ: 150 mg once weekly at weeks 0, 1, 2, 3, and 4, followed by 150 mg every 4 weeks.

Adolescents ≥18 years:

With a loading dose: SUBQ: 150 mg at weeks 0, 1, 2, 3, and 4, followed by 150 mg every 4 weeks; consider an increase to 300 mg every 4 weeks in patients who continue to have active psoriatic arthritis.

Without a loading dose: SUBQ: 150 mg every 4 weeks; consider an increase to 300 mg every 4 weeks in patients who continue to have active ankylosing spondylitis.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Adult

(For additional information see "Secukinumab: Drug information")

Dosage guidance:

Safety: Prior to initiation, certain assessments (clinical and laboratory) are required with documentation and ensure age-appropriate vaccinations are up to date. In general, live vaccines should not be administered within 4 weeks prior to starting therapy (Ref). Refer to institutional protocols for vaccination and monitoring requirements prior to initiating therapy.

Ankylosing spondylitis

Ankylosing spondylitis:

IV:

With a loading dose: 6 mg/kg at week 0 followed by 1.75 mg/kg (do not exceed 300 mg) every 4 weeks.

Without a loading dose: 1.75 mg/kg (do not exceed 300 mg) every 4 weeks.

SUBQ:

With a loading dose: 150 mg at weeks 0, 1, 2, 3, and 4 followed by 150 mg every 4 weeks; consider an increase to 300 mg every 4 weeks in patients who continue to have active ankylosing spondylitis.

Without a loading dose: 150 mg every 4 weeks; consider an increase to 300 mg every 4 weeks in patients who continue to have active ankylosing spondylitis.

Axial spondyloarthritis

Axial spondyloarthritis (nonradiographic):

IV:

With a loading dose: 6 mg/kg at week 0 followed by 1.75 mg/kg (do not exceed 300 mg) every 4 weeks.

Without a loading dose: 1.75 mg/kg (do not exceed 300 mg) every 4 weeks.

SUBQ :

With a loading dose: 150 mg at weeks 0, 1, 2, 3, and 4 followed by 150 mg every 4 weeks.

Without a loading dose: 150 mg every 4 weeks.

Hidradenitis suppurativa

Hidradenitis suppurativa: SUBQ: 300 mg at weeks 0, 1, 2, 3, and 4 followed by 300 mg every 4 weeks; consider an increase to 300 mg every 2 weeks in patients who have an inadequate response.

Plaque psoriasis

Plaque psoriasis: SUBQ : 300 mg once weekly at weeks 0, 1, 2, 3, and 4 followed by 300 mg every 4 weeks. Some patients may only require 150 mg per dose.

Psoriatic arthritis

Psoriatic arthritis:

IV:

With a loading dose: 6 mg/kg at week 0 followed by 1.75 mg/kg (do not exceed 300 mg) every 4 weeks.

Without a loading dose: 1.75 mg/kg (do not exceed 300 mg) every 4 weeks.

SUBQ :

With a loading dose: 150 mg at weeks 0, 1, 2, 3, and 4 followed by 150 mg every 4 weeks; consider an increase to 300 mg every 4 weeks in patients who continue to have active psoriatic arthritis.

Without a loading dose: 150 mg every 4 weeks; consider an increase to 300 mg every 4 weeks in patients who continue to have active psoriatic arthritis.

Coexistent moderate to severe plaque psoriasis: 300 mg once weekly at weeks 0, 1, 2, 3, and 4 followed by 300 mg every 4 weeks. Some patients may only require 150 mg per dose.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Adverse Reactions (Significant): Considerations
Dermatologic reactions

Various cutaneous reactions have been reported, including psoriasiform eruption (either new onset or exacerbation), eczematous rash, lupus-like syndrome, bullous pemphigoid, alopecia, vitiligo, lichen planus, skin granuloma, pyoderma gangrenosum, hidradenitis suppurativa, and hypersensitivity angiitis (Ref). In one systematic review, eczematous rash incidence was reported in 2.6% to 7.6% of patients and led to discontinuation in 76% of patients (Ref).

Mechanism: Not clearly established; psoriasiform reactions, eczematous rashes: Possibly related to imbalances of Th1/Th2 immune response. Hypersensitivity angiitis: Possibly related to cytokine imbalance (Ref). Skin granulomas due to sarcoidosis: Proposed imbalance between interleukin-17 and IFN-γ producing T cells that induce IFN-γ secretion, resulting in granuloma formation (Ref).

Onset: Alopecia: Delayed; 2 to 13 months after initiation (Ref). Eczematous rashes: Delayed; mean 20 weeks (range: 2 to 76 weeks) after initiation (Ref).

Infection

Secukinumab may increase the risk of infection, including serious infection (and sometimes fatal). A higher rate of infections was observed with secukinumab treatment in clinical trials, including nasopharyngitis, upper respiratory tract infection, and candidiasis. Other infections include, but are not limited to, herpes virus infection, histoplasmosis, staphylococcal infection, and toxoplasmosis. Reactivation of hepatitis B virus has also been reported.

Mechanism: Dose-related; cytokine inhibition leads to diminished inflammatory response, especially adaptive immunity, against pathogens. Interleukin (IL)-17 is involved in host immunity against extracellular bacteria and fungi (Ref). Defects in IL-17 immunity are associated with serious infections, including Staphylococcus aureus and herpesvirus skin infections (Ref).

Risk factors:

• History of chronic or recurrent infection

Inflammatory bowel disease

Treatment with secukinumab may cause exacerbations or new onset of inflammatory bowel disease (IBD). Crohn disease, exacerbation of Crohn disease, ulcerative colitis, exacerbation of ulcerative colitis, undifferentiated cases of IBD, and colitis (including microscopic and undifferentiated cases and lymphocytic colitis) have been reported with interleukin (IL)-17 inhibitor use, including secukinumab; fatal cases have occurred (Ref). Overall incidence of IBD with secukinumab is low (Ref).

Mechanism: IL-17 may play a protective role in gastrointestinal inflammation, inhibiting a Th1 immune-mediated response (Ref).

Onset: Varied; usually within 6 months but may occur as late as 39 months (Ref).

Risk factors:

• Psoriasis, psoriatic arthritis, or ankylosing spondylitis (Ref)

• Smoking (Ref)

• Females (Ref)

Tuberculosis

Adult and pediatric patients treated with secukinumab may be at risk for tuberculosis (TB) disease (including reactivated tuberculosis). However, an overall low rate of TB has been reported with secukinumab (Ref).

Mechanism: Interleukin (IL)-17 may promote intracellular growth of Mycobacterium tuberculosis by inhibiting apoptosis of infected macrophages (Ref). Hence, IL-17 inhibition appears to be favorable regarding TB infection; may limit intracellular growth of Mycobacterium tuberculosis by enhancing apoptosis of infected macrophages (Ref).

Risk factors:

• Residence in an area with high TB prevalence (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Infection: Infection (including bacterial infection, opportunistic infection, viral infection: 29% to 48%; fungal infection [4% to 5%]; serious infection: ≤1%) (table 1)

Secukinumab: Adverse Reaction: Infection

Drug (Secukinumab)

Placebo

Population

Dosage Form

Indication

Number of Patients (Secukinumab)

Number of Patients (Placebo)

48%

N/A

Adults

SUBQ

Plaque psoriasis

3,430

N/A

29%

19%

Adults

SUBQ

Plaque psoriasis

1,382

694

Serious: 1%

N/A

Adults

SUBQ

Plaque psoriasis

3,430

N/A

Serious: 0.1%

Serious: 0.3%

Adults

SUBQ

Plaque psoriasis

1,382

694

Respiratory: Nasopharyngitis (11% to 12%) (table 2)

Secukinumab: Adverse Reaction: Nasopharyngitis

Drug (Secukinumab)

Placebo

Population

Dose

Dosage Form

Indication

Number of Patients (Secukinumab)

Number of Patients (Placebo)

12%

9%

Adults

150 mg

SUBQ

Plaque psoriasis

692

694

11%

9%

Adults

300 mg

SUBQ

Plaque psoriasis

691

694

1% to 10%:

Dermatologic: Urticaria (≤1%)

Endocrine & metabolic: Hypercholesterolemia (≥2%)

Gastrointestinal: Diarrhea (3% to 4%), inflammatory bowel disease (≤1%; Crohn disease, exacerbation of Crohn disease, exacerbation of ulcerative colitis, ulcerative colitis: <1%), mucocutaneous candidiasis (1%), nausea (≥2%), oral herpes simplex infection (≤1%)

Nervous system: Headache (≥2%)

Respiratory: Pharyngitis (1%), rhinitis (1%), rhinorrhea (≤1%), upper respiratory tract infection (3%) (table 3)

Secukinumab: Adverse Reaction: Upper Respiratory Tract Infection

Drug (Secukinumab)

Placebo

Population

Dose

Dosage Form

Indication

Number of Patients (Secukinumab)

Number of Patients (Placebo)

3%

0.7%

Adults

300 mg

SUBQ

Plaque psoriasis

691

694

3%

0.7%

Adults

150 mg

SUBQ

Plaque psoriasis

692

694

<1%:

Dermatologic: Impetigo, tinea pedis

Gastrointestinal: Oral candidiasis

Hematologic & oncologic: Neutropenia

Hepatic: Increased serum transaminases

Immunologic: Antibody development (including neutralizing; effect of neutralizing antibodies on safety, efficacy, or PK/PD is unknown)

Ophthalmic: Conjunctivitis

Otic: Otitis externa, otitis media

Respiratory: Sinusitis, tonsillitis

Frequency not defined:

Gastrointestinal: Gastritis, hematochezia, lower abdominal pain

Genitourinary: Urinary tract infection

Hypersensitivity: Anaphylaxis

Postmarketing:

Cardiovascular: Superficial thrombophlebitis (Mammadli 2020)

Dermatologic: Alopecia (Öğüt 2023), bullous pemphigoid (Wang 2023), dyshidrotic eczema (Eichhoff 2020), eczematous rash (Caldarola 2020), lichen planus (oral) (Capusan 2018), psoriasiform eruption (Karamanakos 2021), skin granuloma (Fox 2020)

Gastrointestinal: Aphthous stomatitis (herpetiform) (Benzaquen 2020), colitis (including lymphocytic colitis, microscopic colitis) (Gandu 2022, Megna 2024)

Hematologic & oncologic: Henoch-Schönlein purpura (Perkovic 2021)

Hypersensitivity: Hypersensitivity angiitis (Ak 2023)

Immunologic: Sarcoidosis (Nyckowski 2017)

Infection: Aspergillosis (cutaneous), candidiasis (including esophageal candidiasis, tracheobronchial) (Davidson 2022), cytomegalovirus disease (gastroenteritis/colitis), herpes virus infection (including herpes simplex encephalitis, herpes simplex keratitis) (Davidson 2022), histoplasmosis, reactivation of HBV, staphylococcal infection (Davidson 2022), toxoplasmosis

Local: Injection-site reaction (Grace 2020)

Neuromuscular & skeletal: Lupus-like syndrome (Liang 2022), systemic lupus erythematous (Ávila-Ribeiro 2023)

Respiratory: Pneumonia due to Pneumocystis jirovecii, reactivated tuberculosis

Miscellaneous: Paradoxical reaction (including Behçet syndrome, Behçet-like disease, pyoderma gangrenosum, vitiligo) (Avci 2023, Giordano 2021, Liu 2024)

Contraindications

Serious hypersensitivity reaction to secukinumab or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Eczematous eruptions: Severe eczematous eruptions (sometimes requiring hospitalization), including atopic dermatitis-like eruptions, dyshidrotic eczema, and erythroderma have been reported; the onset ranged from days to months after the first dose. Consider discontinuation of therapy until eczematous eruptions resolve.

• Hypersensitivity reactions: Urticaria and anaphylaxis have been reported; discontinue immediately if signs/symptoms of a serious hypersensitivity reaction develop and initiate appropriate treatment.

• Infections: Secukinumab may increase the risk of infections. Serious and sometimes fatal infections (including bacterial, fungal opportunistic, and viral infections) have been reported. Hepatitis B virus reactivation has occurred. A higher rate of infections was observed with secukinumab treatment in clinical trials, including nasopharyngitis, upper respiratory tract infection, and mucocutaneous candida infection; the incidence of some types of infection appeared to be dose-dependent. Use with caution in patients with a chronic infection or a history of recurrent infection. In patients who develop a serious infection, monitor closely and discontinue use until the infection resolves. Consult a hepatitis specialist if signs of hepatitis B virus reactivation occur; use not recommended in patients with active viral hepatitis.

• Tuberculosis: Patients should be evaluated for tuberculosis (TB) infection (latent TB) prior to initiating therapy; avoid therapy in patients with TB disease (active TB). Consider antituberculosis therapy if an adequate course of treatment cannot be confirmed in patients with a history of TB disease or infection; TB disease has been reported in patients with a history of latent TB.

Disease related concerns:

• Inflammatory bowel disease: Treatment with secukinumab may cause exacerbations (some serious) and new onset of inflammatory bowel disease.

Special populations:

• Patients with rheumatic musculoskeletal disease undergoing hip or knee replacement surgery: Hold biologic disease-modifying antirheumatic drugs (DMARDs) prior to surgery and plan surgery after the next dose is due. Surgery can occur after holding medication for 1 full dosing cycle (eg, for medications administered every 4 weeks, schedule surgery 5 weeks from last administered dose); therapy can be restarted once surgical wound shows evidence of healing (eg, no swelling, erythema, or drainage), sutures/staples are removed, and no ongoing nonsurgical site infections (typically ~14 days to reduce infection risk). Decisions to withhold therapy should be based on shared decision making; ensure the patient and their provider weigh risks of interrupting therapy and disease control versus risks of continuing therapy and surgical complications (ACR/AAHKS [Goodman 2022]).

Dosage form specific issues:

• Latex: Some dosage forms may contain dry natural rubber (latex).

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.

Other warnings/precautions:

• Immunizations: Patients should be brought up to date with all immunizations before initiating therapy. Live vaccines should not be given concurrently during therapy; non-live vaccines administered during secukinumab therapy may not elicit an immune response sufficient to prevent disease.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous [preservative free]:

Cosentyx: 125 mg/5 mL (5 mL) [contains polysorbate 80]

Solution Auto-injector, Subcutaneous [preservative free]:

Cosentyx Sensoready (300 MG): 150 mg/mL (1 mL) [contains mouse (murine) and/or hamster protein, polysorbate 80]

Cosentyx Sensoready Pen: 150 mg/mL (1 mL) [contains polysorbate 80]

Cosentyx UnoReady: 300 mg/2 mL (2 mL) [contains polysorbate 80]

Solution Prefilled Syringe, Subcutaneous:

Cosentyx: 75 mg/0.5 mL (0.5 mL) [contains polysorbate 80]

Solution Prefilled Syringe, Subcutaneous [preservative free]:

Cosentyx: 150 mg/mL (1 mL) [contains polysorbate 80]

Cosentyx (300 MG Dose): 150 mg/mL (1 mL) [contains mouse (murine) and/or hamster protein, polysorbate 80]

Generic Equivalent Available: US

No

Pricing: US

Solution (Cosentyx Intravenous)

125 mg/5 mL (per mL): $517.80

Solution Auto-injector (Cosentyx Sensoready (300 MG) Subcutaneous)

150 mg/mL (per mL): $4,578.74

Solution Auto-injector (Cosentyx Sensoready Pen Subcutaneous)

150 mg/mL (per mL): $9,157.48

Solution Auto-injector (Cosentyx UnoReady Subcutaneous)

300 mg/2 mL (per mL): $4,578.74

Solution Prefilled Syringe (Cosentyx (300 MG Dose) Subcutaneous)

150 mg/mL (per mL): $4,578.74

Solution Prefilled Syringe (Cosentyx Subcutaneous)

75 mg/0.5 mL (per 0.5 mL): $4,578.73

150 mg/mL (per mL): $9,157.48

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Subcutaneous:

Cosentyx: 150 mg/mL (1 mL) [contains mouse (murine) and/or hamster protein, polysorbate 80]

Solution Prefilled Syringe, Subcutaneous:

Cosentyx: 75 mg/0.5 mL (0.5 mL); 150 mg/mL (1 mL) [contains polysorbate 80]

Administration: Pediatric

Note: In pediatric patients, doses can only be administered SUBQ and doses may be administered by a trained adult caregiver; trained adult patients may self-administer.

Parenteral: SUBQ: Allow to reach room temperature prior to injection (prefilled syringes, Sensoready pen: 15 to 30 minutes; UnoReady pen: 30 to 45 minutes). Inject into the front of thighs, any quadrant of the abdomen (≥2 inches away from the navel), or outer upper arms; administer each injection at a different anatomic location than a previous injection and avoid areas where the skin is tender, bruised, erythematous, indurated, or affected by psoriasis, or where there are scars or stretch marks. Do not shake injection device.

Prefilled syringes: Gently pinch skin at injection site, insert needle at a 45-degree angle; slowly and steadily push plunger rod as far as it will go and hold the plunger down and the syringe in place for an additional 5 seconds. Continue to depress the plunger, while pulling needle straight out from injection site.

Autoinjector (Sensoready pen, UnoReady pen): Hold autoinjector firmly against clean skin at a 90-degree angle, and press button. A loud click is heard when injection has begun; continue to hold autoinjector against skin through the second click and until the green indicator stops moving (Sensoready pen) or for a slow count of 5 (UnoReady pen), then lift autoinjector from injection site.

Administration: Adult

IV: Dilute prior to use; allow diluted solution to warm to room temperature prior to initiation of IV infusion. Infuse over 30 minutes (~3.3 mL/minute for 100 mL bag or 1.7 mL/minute for a 50 mL bag), using an infusion set with an in-line, sterile, nonpyrogenic, low protein-binding 0.2-micron filter. After infusion is complete, flush line with NS. Do not infuse in the same line with other medications.

SUBQ : Allow to reach room temperature 15 to 30 minutes (Sensoready pen, 75 mg/0.5 mL prefilled syringe, 150 mg/mL prefilled syringe) or 30 to 45 minutes (UnoReady pen) prior to injection. Inject into the front of thighs, lower abdomen (≥2 inches away from the navel) or outer upper arms; administer each injection at a different anatomic location than a previous injection and avoid areas where the skin is tender, bruised, erythematous, indurated, or affected by psoriasis, or where there are scars or stretch marks. The pens and prefilled syringes may be self-injected by the patient or caregiver following proper training in SUBQ injection technique.

Storage/Stability

Pens and prefilled syringes: Store refrigerated at 2°C to 8°C (36°F to 46°F). Protect from light; keep in original carton. Do not freeze or shake. May store intact Sensoready pens, 150 mg/mL prefilled syringes, and 75 mg/0.5 mL prefilled syringes at ≤30°C (≤86°F) for up to 4 days; may return to the refrigerator once if unused. Discard any unused portion or if stored outside refrigerator >4 days.

Vials: Store refrigerated at 2°C to 8°C (36°F to 46°F). Protect from light; keep in original carton. Do not freeze or shake. If diluted solution is not used immediately, may store at 20°C to 25°C (68°F to 77°F) for up to 4.5 hours (preparation to end of infusion) or refrigerated for up to 24 hours (preparation to end of infusion). Protect infusion from light when stored under refrigeration.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:

Cosentyx: https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/125504s082lbl.pdf#page=33

Use

Treatment of active psoriatic arthritis (FDA approved in ages ≥2 years and adults); treatment of active enthesitis-related arthritis (FDA approved in pediatric patients ≥4 years of age); treatment of moderate to severe plaque psoriasis in patients who are candidates for systemic therapy or phototherapy (FDA approved in ages ≥6 years and adults); treatment of active nonradiographic axial spondyloarthritis with objective signs of inflammation (FDA approved in adults); treatment of active ankylosing spondylitis (FDA approved in adults); treatment of hidradenitis suppurativa (FDA approved in adults).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Abrocitinib: May increase immunosuppressive effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid

Anifrolumab: Biologic Anti-Psoriasis Agents may increase immunosuppressive effects of Anifrolumab. Risk X: Avoid

Antithymocyte Globulin (Equine): Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of immunosuppressive therapy is reduced. Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor

Baricitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Baricitinib. Risk X: Avoid

BCG Products: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of BCG Products. Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Belimumab: May increase immunosuppressive effects of Biologic Anti-Psoriasis Agents. Management: Consider alternatives to the use of belimumab with other biologic therapies. Monitor closely for increased toxicities related to additive immunosuppression (ie, infection, malignancy) if combined. Risk D: Consider Therapy Modification

Brincidofovir: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Brincidofovir. Risk C: Monitor

Brivudine: May increase adverse/toxic effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid

Chikungunya Vaccine (Live): Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid

Cladribine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Cladribine. Risk X: Avoid

Coccidioides immitis Skin Test: Coadministration of Immunosuppressants (Therapeutic Immunosuppressant Agents) and Coccidioides immitis Skin Test may alter diagnostic results. Management: Consider discontinuing therapeutic immunosuppressants several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider Therapy Modification

COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor

COVID-19 Vaccine (mRNA): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider Therapy Modification

COVID-19 Vaccine (Subunit): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of COVID-19 Vaccine (Subunit). Risk C: Monitor

Dengue Tetravalent Vaccine (Live): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Dengue Tetravalent Vaccine (Live). Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Denosumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Denosumab. Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and immunosuppressants. If combined, monitor for signs/symptoms of serious infections. Risk D: Consider Therapy Modification

Deucravacitinib: May increase immunosuppressive effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid

Efgartigimod Alfa: May decrease therapeutic effects of Fc Receptor-Binding Agents. Risk C: Monitor

Etrasimod: May increase immunosuppressive effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid

Filgotinib: May increase immunosuppressive effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid

Inebilizumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Inebilizumab. Risk C: Monitor

InFLIXimab: May increase immunosuppressive effects of Biologic Anti-Psoriasis Agents. Risk X: Avoid

Influenza Virus Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating immunosuppressants if possible. If vaccination occurs less than 2 weeks prior to or during therapy, revaccinate 2 to 3 months after therapy discontinued if immune competence restored. Risk D: Consider Therapy Modification

Leflunomide: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents. Risk D: Consider Therapy Modification

Mumps- Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Nadofaragene Firadenovec: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid

Natalizumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Natalizumab. Risk X: Avoid

Nipocalimab: May decrease therapeutic effects of Fc Receptor-Binding Agents. Risk C: Monitor

Ocrelizumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Ocrelizumab. Risk C: Monitor

Ofatumumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Ofatumumab. Risk C: Monitor

Pidotimod: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Pidotimod. Risk C: Monitor

Pimecrolimus: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Pimecrolimus. Risk X: Avoid

Pneumococcal Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Pneumococcal Vaccines. Risk C: Monitor

Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Polymethylmethacrylate: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase hypersensitivity effects of Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider Therapy Modification

Rabies Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider Therapy Modification

Ritlecitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Ritlecitinib. Risk X: Avoid

Rozanolixizumab: May decrease therapeutic effects of Fc Receptor-Binding Agents. Risk C: Monitor

Ruxolitinib (Topical): Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Ruxolitinib (Topical). Risk X: Avoid

Sipuleucel-T: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants prior to initiating sipuleucel-T therapy. Risk D: Consider Therapy Modification

Sphingosine 1-Phosphate (S1P) Receptor Modulators: May increase immunosuppressive effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk C: Monitor

Tacrolimus (Topical): Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Tacrolimus (Topical). Risk X: Avoid

Talimogene Laherparepvec: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid

Tertomotide: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Tertomotide. Risk X: Avoid

Tofacitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Tofacitinib. Management: Coadministration of tofacitinib with potent immunosuppressants is not recommended. Use with non-biologic disease-modifying antirheumatic drugs (DMARDs) was permitted in psoriatic arthritis clinical trials. Risk X: Avoid

Typhoid Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Typhoid Vaccine. Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Ublituximab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Ublituximab. Risk C: Monitor

Upadacitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Upadacitinib. Risk X: Avoid

Vaccines (Live): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Vaccines (Live). Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Vaccines (Non-Live/Inactivated/Non-Replicating): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to starting immunosuppressants when possible. Patients vaccinated less than 14 days before or during therapy should be revaccinated at least 2 to 3 months after therapy is complete. Risk D: Consider Therapy Modification

Yellow Fever Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Yellow Fever Vaccine. Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Zoster Vaccine (Live/Attenuated): Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Zoster Vaccine (Live/Attenuated). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Zoster Vaccine (Live/Attenuated). Risk X: Avoid

Reproductive Considerations

The American Academy of Dermatology considers secukinumab for the treatment of psoriasis to be likely compatible for use in male patients planning to father a child (AAD-NPF [Menter 2019]). Males and females with well-controlled psoriasis who are planning a pregnancy and wish to avoid fetal exposure can consider discontinuing secukinumab 19 weeks prior to attempting pregnancy (Rademaker 2018).

Based on limited information, use of secukinumab may be continued through conception in patients with rheumatic and musculoskeletal diseases who are planning to become pregnant and not able to use alternative therapies; use should be discontinued once pregnancy is confirmed. Conception should be planned during a period of quiescent/low disease activity. Recommendations for use of secukinumab to treat rheumatic and musculoskeletal diseases in patients who are planning to father a child are not available due to limited data (ACR [Sammaritano 2020]).

Possible failure of tubal sterilization following placement of an implantable birth control device (Essure) was observed in a female treated with secukinumab (Nardin 2018). Note: Distribution of Essure in the United States was stopped in December 2018.

Pregnancy Considerations

Secukinumab is a humanized monoclonal antibody (IgG1). Placental transfer of human IgG is dependent upon the IgG subclass, maternal serum concentrations, birth weight, and gestational age, generally increasing as pregnancy progresses. The lowest exposure would be expected during the period of organogenesis (Palmeira 2012; Pentsuk 2009).

Outcome information following exposure to secukinumab during pregnancy is limited (Liu 2020; Nardin 2018; Warren 2018).

Until additional information is available, secukinumab is not currently recommended for the treatment of rheumatic and musculoskeletal diseases during pregnancy. Secukinumab should be discontinued once pregnancy is confirmed (ACR [Sammaritano 2020]). Agents other than secukinumab are preferred for the treatment of plaque psoriasis during pregnancy (Yeung 2020).

Monitoring Parameters

Tuberculosis (TB) screening prior to initiating and during therapy (yearly if high risk); baseline hepatitis virus and HIV screening in patients with relevant risk factors, pregnancy test in patients who can become pregnant (AAD-NPF [Menter 2020]; EuroGuiDerm [Nast 2020]); CBC and liver enzymes at baseline and after 3 to 6 months of therapy (EuroGuiDerm [Nast 2020]), signs and symptoms of infection or inflammatory bowel disease.

Mechanism of Action

Secukinumab is a human IgG1 monoclonal antibody that selectively binds to the interleukin-17A (IL-17A) cytokine and inhibits its interaction with the IL-17 receptor. IL-17A is a naturally occurring cytokine involved in normal inflammatory and immune responses. Secukinumab inhibits the release of proinflammatory cytokines and chemokines.

Pharmacokinetics (Adult Data Unless Noted)

Note: Weight: Secukinumab clearance and volume of distribution increase as body weight increases.

Onset of action: Psoriasis: SUBQ: Response best determined after 12 weeks (AAD-NPF [Menter 2019]).

Distribution: Vd: SUBQ: 7.1 to 8.6 L.

Metabolism: Expected to be degraded into small peptides and amino acids via catabolic pathways similar to that which is seen with endogenous IgG.

Bioavailability: SUBQ: 55% to 77%.

Half-life elimination: SUBQ: 22 to 31 days.

Time to peak: SUBQ: ~6 days.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Cosentyx;
  • (AR) Argentina: Cosentyx;
  • (AT) Austria: Cosentyx;
  • (AU) Australia: Cosentyx;
  • (BD) Bangladesh: Cosentyx;
  • (BE) Belgium: Cosentyx;
  • (BG) Bulgaria: Cosentyx;
  • (BR) Brazil: Cosentyx;
  • (CH) Switzerland: Cosentyx;
  • (CL) Chile: Cosentyx;
  • (CN) China: Cosentyx;
  • (CO) Colombia: Cosentyx;
  • (CZ) Czech Republic: Cosentyx;
  • (DE) Germany: Cosentyx;
  • (DO) Dominican Republic: Cosentyx | Scapho;
  • (EC) Ecuador: Cosentyx;
  • (EE) Estonia: Cosentyx;
  • (EG) Egypt: Cosentyx;
  • (ES) Spain: Cosentyx;
  • (ET) Ethiopia: Cosentyx;
  • (FI) Finland: Cosentyx;
  • (FR) France: Cosentyx;
  • (GB) United Kingdom: Cosentyx;
  • (GR) Greece: Cosentyx;
  • (HK) Hong Kong: Cosentyx;
  • (HR) Croatia: Cosentyx;
  • (HU) Hungary: Cosentyx;
  • (ID) Indonesia: Fraizeron;
  • (IE) Ireland: Cosentyx;
  • (IN) India: Scapho;
  • (IT) Italy: Cosentyx;
  • (JO) Jordan: Cosentyx;
  • (JP) Japan: Cosentyx;
  • (KR) Korea, Republic of: Cosentyx | Cosentyx sensoready;
  • (KW) Kuwait: Cosentyx;
  • (LB) Lebanon: Cosentyx;
  • (LT) Lithuania: Cosentyx;
  • (LU) Luxembourg: Cosentyx;
  • (LV) Latvia: Cosentyx;
  • (MA) Morocco: Cosentyx;
  • (MX) Mexico: Cosentyx;
  • (MY) Malaysia: Cosentyx | Fraizeron;
  • (NL) Netherlands: Cosentyx;
  • (NO) Norway: Cosentyx;
  • (NZ) New Zealand: Cosentyx;
  • (PE) Peru: Cosentyx;
  • (PH) Philippines: Cosentyx | Scapho;
  • (PK) Pakistan: Cosentyx;
  • (PL) Poland: Cosentyx;
  • (PR) Puerto Rico: Cosentyx;
  • (PT) Portugal: Cosentyx;
  • (QA) Qatar: Cosentyx | Cosentyx (300 mg Dose) | Cosentyx Sensoready | Cosentyx Sensoready (300 mg Dose);
  • (RO) Romania: Cosentyx;
  • (RU) Russian Federation: Cosentyx;
  • (SA) Saudi Arabia: Cosentyx;
  • (SE) Sweden: Cosentyx;
  • (SG) Singapore: Cosentyx;
  • (SI) Slovenia: Cosentyx;
  • (SK) Slovakia: Cosentyx;
  • (TH) Thailand: Cosentyx | Scapho;
  • (TN) Tunisia: Cosentyx;
  • (TR) Turkey: Verxant;
  • (TW) Taiwan: Cosentyx;
  • (UA) Ukraine: Scapho;
  • (ZA) South Africa: Cosentyx
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