Publication:

Secukinumab - a stupendous option in psoriasis management

Psoriasis is a chronic inflammatory skin disease with increased epidermal proliferation related to dysregulation of the immune system. In spite of several therapeutic strategies available for the treatment of this condition, the disease causes untold suffering particularly in the severe variant of the disease. Secukinumab is a human IgG1 monoclonal antibody that binds to the cytokine interleukin-17A (IL-17A) inhibiting the pro-inflammatory effects that are involved in the development of plaque psoriasis. Secukinumab 300mg is to be given via subcutaneous injection at weeks 0, 1, 2, 3 and 4 and once monthly thereafter. The efficacy of secukinumab has been evaluated in three phase 3 clinical trials. The drug showed an overwhelming improvement in the primary end points as assessed by PASI 75 and modified IGA scores.  The only major concern with secukinumab is the increased risk of nasopharyngitis and mucocutaneous candidiasis due to the interference with host defence mechanisms by targeting IL-17.  Secukinumab has also shown favorable response in the treatment of psoriatic arthritis, ankylosing spondylitis from clinical trials. The drug has been approved by the US FDA in January 2015 for the treatment of moderate to severe psoriasis in patients who require systemic therapy. Nevertheless long term safety data are still awaited. While the results of these trials have been extremely gratifying, it remains to be seen if the stupendous performance displayed in clinical trials could be translated in real world practice.