Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.
If you were prescribed this medicine, other products containing Secukinumab may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.
for
Cosentyx contains the active substance secukinumab. Secukinumab is a monoclonal antibody which belongs to a group of medicines called interleukin (IL) inhibitors. This medicine works by neutralising the activity of a protein called IL-17A, which is present at increased levels in diseases such as psoriasis, hidradenitis suppurativa, psoriatic arthritis and axial spondyloarthritis. Cosentyx is used for the treatment of the following inflammatory diseases: • Plaque psoriasis • Hidradenitis suppurativa • Psoriatic arthritis • Axial spondyloarthritis, including ankylosing spondylitis (radiographic axial spondyloarthritis) and non-radiographic axial spondyloarthritis • Juvenile idiopathic arthritis, including enthesitis-related arthritis and juvenile psoriatic arthritis Plaque psoriasis Cosentyx is used to treat a skin condition called "plaque psoriasis", which causes inflammation affecting the skin. Cosentyx reduces the inflammation and other symptoms of the disease. Cosentyx is used in adults, adolescents and children (6 years of age and older) with moderate to severe plaque psoriasis. Using Cosentyx in plaque psoriasis will benefit you by leading to improvements of skin clearance and reducing your symptoms such as scaling, itching and pain. Hidradenitis suppurativa Cosentyx is used to treat a condition called hidradenitis suppurativa, also sometimes called acne inversa or Verneuil's disease. This condition is a chronic and painful inflammatory skin disease. Symptoms may include tender nodules (lumps) and abscesses (boils) that may leak pus. It commonly affects specific areas of the skin, such as under the breasts, the armpits, inner thighs, groin and buttocks. Scarring may also occur in affected areas.
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Cosentyx can reduce the number of nodules and abscesses you have and the pain that is often associated with the disease. If you have hidradenitis suppurativa you will first be given other medicines. If you do not respond well enough to these medicines, you will be given Cosentyx. Cosentyx is used in adults with hidradenitis suppurativa and can be used alone or with antibiotics. Psoriatic arthritis Cosentyx is used to treat a condition called "psoriatic arthritis". The condition is an inflammatory disease of the joints, often accompanied by psoriasis. If you have active psoriatic arthritis you will first be given other medicines. If you do not respond well enough to these medicines, you will be given Cosentyx to reduce the signs and symptoms of active psoriatic arthritis, improve physical function and slow down the damage to the cartilage and bone of the joints involved in the disease. Cosentyx is used in adults with active psoriatic arthritis and can be used alone or with another medicine called methotrexate. Using Cosentyx in psoriatic arthritis will benefit you by reducing the signs and symptoms of the disease, slowing down the damage to the cartilage and bone of the joints and improving your ability to do normal daily activities. Axial spondyloarthritis, including ankylosing spondylitis (radiographic axial spondyloarthritis) and non-radiographic axial spondyloarthritis Cosentyx is used to treat conditions called "ankylosing spondylitis" and "non-radiographic axial spondyloarthritis". These conditions are inflammatory diseases primarily affecting the spine which cause inflammation of the spinal joints. If you have ankylosing spondylitis or non-radiographic axial spondyloarthritis you will first be given other medicines. If you do not respond well enough to these medicines, you will be given Cosentyx to reduce the signs and symptoms of the disease, reduce inflammation and improve your physical function. Cosentyx is used in adults with active ankylosing spondylitis and active non-radiographic axial spondyloarthritis. Using Cosentyx in ankylosing spondylitis and non-radiographic axial spondyloarthritis will benefit you by reducing the signs and symptoms of your disease and improving your physical function. Juvenile idiopathic arthritis, including enthesitis-related arthritis and juvenile psoriatic arthritis Cosentyx is used in patients (6 years of age and older) to treat conditions of the juvenile idiopathic arthritis categories called "enthesitis-related arthritis" and "juvenile psoriatic arthritis". These conditions are inflammatory diseases affecting the joints and the places where tendons join the bone. Using Cosentyx in enthesitis-related arthritis and juvenile psoriatic arthritis will benefit you (or your child) by reducing the symptoms and improving your (or your child's) physical function. 2.
e Cosentyx
Do not use Cosentyx: • if you are allergic to secukinumab or any of the other ingredients of this medicine (listed in section 6). If you think you may be allergic, ask your doctor for advice before using Cosentyx. • if you have an active infection which your doctor thinks is important (for example, active tuberculosis). Warnings and precautions Talk to your doctor, nurse or pharmacist before using Cosentyx: • if you currently have an infection. • if you have long-term or repeated infections. 2
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if you have ever had an allergic reaction to latex. if you have an inflammatory disease affecting your gut called Crohn's disease. if you have an inflammation of your large intestine called ulcerative colitis. if you have recently had a vaccination or if you are due to have a vaccination during treatment with Cosentyx. if you are receiving any other treatment for psoriasis, such as another immunosuppressant or phototherapy with ultraviolet (UV) light.
Tuberculosis Talk to your doctor if you have or previously had tuberculosis. Also tell your doctor if you have recently been in close contact with someone who has tuberculosis. Your doctor will evaluate you and may do a test for tuberculosis before you use Cosentyx. If your doctor thinks you are at risk of tuberculosis, you may be given medicines to treat it. If symptoms of tuberculosis (such as persistent cough, weight loss, listlessness or mild fever) appear during treatment with Cosentyx, tell your doctor immediately. Hepatitis B Talk to your doctor if you have or previously had a hepatitis B infection. This medicine may cause a reactivation of the infection. Before and during secukinumab treatment, your doctor may check you for signs of infection. Tell your doctor if you notice any of the following symptoms: worsening tiredness, yellowing of the skin or white part of the eyes, dark urine, loss of appetite, nausea and/or pain in the upper right side of the stomach area. Inflammatory bowel disease (Crohn's disease or ulcerative colitis) Stop using Cosentyx and tell your doctor or seek medical help immediately if you notice abdominal cramps and pain, diarrhoea, weight loss, blood in the stool or any other signs of bowel problems. Look out for infections and allergic reactions Cosentyx can potentially cause serious side effects, including infections and allergic reactions. You must look out for signs of these conditions while you are taking Cosentyx. Stop using Cosentyx and tell your doctor or seek medical help immediately if you notice any signs indicating a possible serious infection or an allergic reaction. Such signs are listed under "Serious side effects" in section 4. Children and adolescents Cosentyx is not recommended for children younger than 6 years of age with plaque psoriasis because it has not been studied in this age group. Cosentyx is not recommended for children younger than 6 years of age with juvenile idiopathic arthritis (enthesitis-related arthritis and juvenile psoriatic arthritis). Cosentyx is not recommended for children and adolescents (under 18 years of age) in other indications because it has not been studied in this age group. Other medicines and Cosentyx Tell your doctor or pharmacist: • if you are taking, have recently taken or might take any other medicines. • if you have recently had or are due to have a vaccination. You should not be given certain types of vaccines (live vaccines) while using Cosentyx. Pregnancy, breast-feeding and fertility • It is preferable to avoid the use of Cosentyx in pregnancy. The effects of this medicine in pregnant women are not known. If you are a woman of childbearing potential, you are advised to avoid becoming pregnant and must use adequate contraception while using Cosentyx and for at least 20 weeks after the last Cosentyx dose. 3
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Talk to your doctor if you are pregnant, think you may be pregnant or are planning to have a baby. Talk to your doctor if you are breast-feeding or are planning to breast-feed. You and your doctor should decide if you will breast-feed or use Cosentyx. You should not do both. After using Cosentyx you should not breast-feed for at least 20 weeks after the last dose.
Driving and using machines Cosentyx is unlikely to influence your ability to drive and use machines. 3.
How to use Cosentyx
Always use this medicine exactly as your doctor has told you. Check with your doctor, nurse or pharmacist if you are not sure. Cosentyx is given via injection under your skin (known as a subcutaneous injection). You and your doctor should decide if you should inject Cosentyx yourself. It is important not to try to inject yourself until you have been trained by your doctor, nurse or pharmacist. A caregiver may also give you your Cosentyx injection after proper training. For detailed instructions on how to inject Cosentyx, see "Instructions for use of the Cosentyx 150 mg SensoReady pen" at the end of this leaflet.
and for how long Your doctor will decide how much Cosentyx you need and for how long. Plaque psoriasis Adult • The recommended dose is 300 mg by subcutaneous injection. • Each 300 mg dose is given as two injections of 150 mg. After the first dose you will receive further weekly injections at weeks 1, 2, 3 and 4 followed by monthly injections. Based on your response, further adjustments to your dose may be recommended by your doctor. At each timepoint you will receive a 300 mg dose given as two injections of 150 mg. Children aged 6 years and older • The recommended dose is based on body weight as follows: o Weight below 25 kg: 75 mg by subcutaneous injection. o Weight 25 kg or above and below 50 kg: 75 mg by subcutaneous injection. o Weight 50 kg or above: 150 mg by subcutaneous injection. Your doctor may increase the dose to 300 mg. • Each 150 mg dose is given as one injection of 150 mg. Other dosage forms/strengths may be available for administration of the 75 mg and 300 mg doses. After the first dose you will receive further weekly injections at weeks 1, 2, 3 and 4 followed by monthly injections. Hidradenitis suppurativa • The recommended dose is 300 mg by subcutaneous injection. • Each 300 mg dose is given as two injections of 150 mg. After the first dose you will receive further weekly injections at weeks 1, 2, 3 and 4 followed by monthly injections. Based on your response, further adjustments to your dose may be recommended by your doctor.
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Psoriatic arthritis If you have both psoriatic arthritis and also moderate to severe plaque psoriasis, your doctor may adjust the dose recommendation as needed. For patients who did not respond well to medicines called tumour necrosis factor (TNF) blockers: • The recommended dose is 300 mg by subcutaneous injection. • Each 300 mg dose is given as two injections of 150 mg. After the first dose you will receive further weekly injections at weeks 1, 2, 3 and 4 followed by monthly injections. At each timepoint you will receive a 300 mg dose given as two injections of 150 mg. For other psoriatic arthritis patients: • The recommended dose is 150 mg by subcutaneous injection. After the first dose you will receive further weekly injections at weeks 1, 2, 3 and 4 followed by monthly injections. Based on your response, your doctor may increase your dose to 300 mg. Ankylosing spondylitis (Radiographic axial spondyloarthritis) • The recommended dose is 150 mg by subcutaneous injection. After the first dose you will receive further weekly injections at weeks 1, 2, 3 and 4 followed by monthly injections. Based on your response, your doctor may increase your dose to 300 mg. Each 300 mg dose is given as two injections of 150 mg. Non-radiographic axial spondyloarthritis • The recommended dose is 150 mg by subcutaneous injection. After the first dose you will receive further weekly injections at weeks 1, 2, 3 and 4 followed by monthly injections. Juvenile idiopathic arthritis (enthesitis-related arthritis and juvenile psoriatic arthritis) • The recommended dose is based on body weight as follows: o Weight below 50 kg: 75 mg by subcutaneous injection. o Weight 50 kg or above: 150 mg by subcutaneous injection. • Each 150 mg dose is given as one injection of 150 mg. Other dosage forms/strengths may be available for administration of the 75 mg dose. After the first dose you will receive further weekly injections at weeks 1, 2, 3 and 4 followed by monthly injections. Cosentyx is for long-term treatment. Your doctor will regularly monitor your condition to check that the treatment is having the desired effect. If you use more Cosentyx than you should If you have received more Cosentyx than you should or the dose has been administered sooner than according to your doctor's prescription, inform your doctor. If you forget to use Cosentyx If you have forgotten to inject a dose of Cosentyx, inject the next dose as soon as you remember. Then talk to your doctor to discuss when you should inject the next dose.
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If you stop using Cosentyx It is not dangerous to stop using Cosentyx. However, if you stop, your psoriasis, psoriatic arthritis or axial spondyloarthritis symptoms may come back. If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse. 4.
Like all medicines, this medicine can cause side effects, although not everybody gets them. Serious side effects Stop using Cosentyx and tell your doctor or seek medical help immediately if you get any of the following side effects: Possible serious infection – the signs may include: • fever, flu-like symptoms, night sweats • feeling tired or short of breath, cough which will not go away • warm, red and painful skin, or a painful skin rash with blisters • burning sensation when passing urine. Serious allergic reaction – the signs may include: • difficulty breathing or swallowing • low blood pressure, which can cause dizziness or light-headedness • swelling of the face, lips, tongue or throat • severe itching of the skin, with a red rash or raised bumps. Your doctor will decide if and when you may restart the treatment. Other side effects Most of the following side effects are mild to moderate. If any of these side effects becomes severe, tell your doctor, pharmacist or nurse. Very common (may affect more than 1 in 10 people): • upper respiratory tract infections with symptoms such as sore throat and stuffy nose (nasopharyngitis, rhinitis) Common (may affect up to 1 in 10 people): • cold sores (oral herpes) • diarrhoea • runny nose (rhinorrhoea) • headache • nausea • fatigue • itchy, red and dry skin (eczema) Uncommon (may affect up to 1 in 100 people): • oral thrush (oral candidiasis) • signs of low levels of white blood cells, such as fever, sore throat or mouth ulcers due to infections (neutropenia) • infection of the external ear (otitis externa) • discharge from the eye with itching, redness and swelling (conjunctivitis) • itchy rash (urticaria) • lower respiratory tract infections • abdominal cramps and pain, diarrhoea, weight loss or blood in the stool (signs of bowel
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problems) small, itchy blisters on the palms of hands, soles of feet and edges of the fingers and toes (dyshidrotic eczema) athlete's foot (tinea pedis)
Rare (may affect up to 1 in 1 000 people): • severe allergic reaction with shock (anaphylactic reaction) • redness and shedding of skin over a larger area of the body, which may be itchy or painful (exfoliative dermatitis) • inflammation of small blood vessels, which can lead to a skin rash with small red or purple bumps (vasculitis) • swelling of the neck, face, mouth or throat which may lead to difficulty swallowing or breathing (angioedema) Not known (frequency cannot be estimated from the available data): • fungal infections of the skin and mucous membranes (including oesophageal candidiasis) • painful swelling and skin ulceration (pyoderma gangrenosum) Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine. 5.
Cosentyx
Keep this medicine out of the sight and reach of children. Do not use this medicine: • after the expiry date which is stated on the outer box or the label on the pen after "EXP". • if the liquid contains easily visible particles, is cloudy or is distinctly brown. Store the pen sealed in its box to protect from light. Store in the refrigerator between 2°C and 8°C. Do not freeze. Do not shake. If necessary, Cosentyx can be left out of the refrigerator for a single period of up to 4 days at room temperature, not above 30°C. This medicine is for single use only. Do not throw away any medicines via wastewater. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment. 6.
What Cosentyx contains The active substance is secukinumab. Each pre-filled pen contains 150 mg secukinumab. The other ingredients are trehalose dihydrate, histidine, histidine hydrochloride monohydrate, methionine, polysorbate 80 and water for injections. What Cosentyx looks like and contents of the pack Cosentyx solution for injection is a clear liquid. Its colour may vary from colourless to slightly yellow. Cosentyx 150 mg solution for injection in pre-filled pen is available in unit packs containing 1 or 2 pre-filled pen(s) and in multipacks containing 6 (3 packs of 2) pre-filled pens. Not all pack sizes may 7
be marketed. Marketing Authorisation Holder and Manufacturer Novartis Pharmaceuticals UK Limited, 2nd Floor, The WestWorks Building, White City Place, 195 Wood Lane, London, W12 7FQ, United Kingdom. For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder: United Kingdom Novartis Pharmaceuticals UK Ltd. Tel: +44 1276 698370 This leaflet was last revised in 05/2025
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Instructions for use of the Cosentyx 150 mg SensoReady pen Cosentyx 150 mg SensoReady pen Solution for injection in a pre-filled pen Secukinumab Patient Instructions for Use
Read ALL the way through these instructions before injecting. These instructions are to help you to inject correctly using the Cosentyx SensoReady pen. It is important not to try to inject yourself or the person in your care until you have been trained by your doctor, nurse or pharmacist.
Your Cosentyx 150 mg SensoReady pen: Store your boxed pen in a refrigerator between 2°C and 8°C and out of the reach of children.
Needle Needle guard Cap
Inspection window Internal needle cover
Cosentyx 150 mg SensoReady pen shown with the cap removed. Do not remove the cap until you are ready to inject.
• • •
Do not freeze the pen. Do not shake the pen. Do not use the pen if it has been dropped with the cap removed.
For a more comfortable injection, take the pen out of the refrigerator 15-30 minutes before injecting to allow it to reach room temperature.
What you need for your injection: Included in the carton:
Not included in the carton:
A new and unused Cosentyx 150 mg SensoReady pen (1 pen is needed for a 150 mg dose and 2 pens are needed for a 300 mg dose).
• • •
Alcohol swab. Cotton ball or gauze. Sharps disposal container.
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Before your injection: 1. Important safety checks before you inject: The liquid should be clear. Its colour may vary from colourless to slightly yellow. Do not use if the liquid contains easily visible particles, is cloudy or is distinctly brown. You may see a small air bubble, which is normal. Do not use the pen if the expiry date has passed. Do not use if the safety seal has been broken. Contact your pharmacist if the pen fails any of these checks. 2a. Choose your injection site:
3. Cleaning your injection site:
Your injection: 4. Removing the cap:
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5. Holding your pen:
Correct
Incorrect
YOU MUST READ THIS BEFORE INJECTING. During the injection you will hear 2 loud clicks. The 1st click indicates that the injection has started. Several seconds later a 2nd click will indicate that the injection is almost finished. You must keep holding the pen firmly against your skin until you see a green indicator fill the window and stop moving. 6. Starting your injection:
7. Completing your injection:
After your injection: 8. Check the green indicator fills the window:
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9. Disposing of your Cosentyx SensoReady pen:
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Cosentyx 150 mg solution for injection in pre-filled pen comes as injection containing 150mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.
The active substance in Cosentyx 150 mg solution for injection in pre-filled pen is secukinumab.
Medicines with the same active substance, strength and form include: Cosentyx 150 mg solution for injection in pre-filled syringe. They are interchangeable only if your prescriber or pharmacist says so.
This leaflet reproduces the patient information leaflet approved for Cosentyx 150 mg solution for injection in pre-filled pen, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.
Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.
The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.
Adult plaque psoriasis
Cosentyx is indicated for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy.
Paediatric plaque psoriasis
Cosentyx is indicated for the treatment of moderate to severe plaque psoriasis in children and adolescents from the age of 6 years who are candidates for systemic therapy.
Hidradenitis suppurativa (HS)
Cosentyx is indicated for the treatment of active moderate to severe hidradenitis suppurativa (acne inversa) in adults with an inadequate response to conventional systemic HS therapy (see section 5.1).
Psoriatic arthritis
Cosentyx, alone or in combination with methotrexate (MTX), is indicated for the treatment of active psoriatic arthritis in adult patients when the response to previous disease‑modifying anti‑rheumatic drug (DMARD) therapy has been inadequate (see section 5.1).
Axial spondyloarthritis (axSpA)
Ankylosing spondylitis (AS, radiographic axial spondyloarthritis)
Cosentyx is indicated for the treatment of active ankylosing spondylitis in adults who have responded inadequately to conventional therapy.
Non-radiographic axial spondyloarthritis (nr-axSpA)
Cosentyx is indicated for the treatment of active non-radiographic axial spondyloarthritis with objective signs of inflammation as indicated by elevated C-reactive protein (CRP) and/or magnetic resonance imaging (MRI) evidence in adults who have responded inadequately to non‑steroidal anti‑inflammatory drugs (NSAIDs).
Juvenile idiopathic arthritis (JIA)
Enthesitis-related arthritis (ERA)
Cosentyx, alone or in combination with methotrexate (MTX), is indicated for the treatment of active enthesitis-related arthritis in patients 6 years and older whose disease has responded inadequately to, or who cannot tolerate, conventional therapy (see section 5.1).
Juvenile psoriatic arthritis (JPsA)
Cosentyx, alone or in combination with methotrexate (MTX), is indicated for the treatment of active juvenile psoriatic arthritis in patients 6 years and older whose disease has responded inadequately to, or who cannot tolerate, conventional therapy (see section 5.1).
Cosentyx is intended for use under the guidance and supervision of a physician experienced in the diagnosis and treatment of conditions for which Cosentyx is indicated.
Posology
Adult plaque psoriasis
The recommended dose is 300 mg of secukinumab by subcutaneous injection with initial dosing at weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. Based on clinical response, a maintenance dose of 300 mg every 2 weeks may provide additional benefit for patients with a body weight of 90 kg or higher. Each 300 mg dose is given as one subcutaneous injection of 300 mg or as two subcutaneous injections of 150 mg.
Paediatric plaque psoriasis (adolescents and children from the age of 6 years)
The recommended dose is based on body weight (Table 1) and administered by subcutaneous injection with initial dosing at weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. Each 75 mg dose is given as one subcutaneous injection of 75 mg. Each 150 mg dose is given as one subcutaneous injection of 150 mg. Each 300 mg dose is given as one subcutaneous injection of 300 mg or as two subcutaneous injections of 150 mg.
Table 1 Recommended dose for paediatric plaque psoriasis
Body weight at time of dosing
Recommended dose
<25 kg
75 mg
25 to <50 kg
75 mg
≥50 kg
150 mg (*may be increased to 300 mg)
*Some patients may derive additional benefit from the higher dose.
The 150 mg and 300 mg solution for injection in pre-filled syringe and in pre-filled pen are not indicated for administration to paediatric patients with a weight <50 kg. Cosentyx may be available in other strengths and/or presentations depending on the individual treatment needs.
Hidradenitis suppurativa (HS)
The recommended dose is 300 mg of secukinumab by subcutaneous injection with initial dosing at weeks 0, 1, 2, 3, and 4, followed by monthly maintenance dosing. Based on clinical response, the maintenance dose can be increased to 300 mg every 2 weeks. Each 300 mg dose is given as one subcutaneous injection of 300 mg or as two subcutaneous injections of 150 mg.
Psoriatic arthritis
For patients with concomitant moderate to severe plaque psoriasis, please refer to adult plaque psoriasis recommendation.
For patients who are anti‑TNFα inadequate responders (IR), the recommended dose is 300 mg by subcutaneous injection with initial dosing at weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. Each 300 mg dose is given as one subcutaneous injection of 300 mg or as two subcutaneous injections of 150 mg.
For other patients, the recommended dose is 150 mg by subcutaneous injection with initial dosing at weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. Based on clinical response, the dose can be increased to 300 mg.
Axial spondyloarthritis (axSpA)
Ankylosing spondylitis (AS, radiographic axial spondyloarthritis)
The recommended dose is 150 mg by subcutaneous injection with initial dosing at weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. Based on clinical response, the dose can be increased to 300 mg. Each 300 mg dose is given as one subcutaneous injection of 300 mg or as two subcutaneous injections of 150 mg.
Non-radiographic axial spondyloarthritis (nr-axSpA)
The recommended dose is 150 mg by subcutaneous injection with initial dosing at weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing.
Juvenile idiopathic arthritis (JIA)
Enthesitis-related arthritis (ERA) and juvenile psoriatic arthritis (JPsA)
The recommended dose is based on body weight (Table 2) and administered by subcutaneous injection at weeks 0, 1, 2, 3, and 4, followed by monthly maintenance dosing. Each 75 mg dose is given as one subcutaneous injection of 75 mg. Each 150 mg dose is given as one subcutaneous injection of 150 mg.
Table 2 Recommended dose for juvenile idiopathic arthritis
Body weight at time of dosing
Recommended dose
<50 kg
75 mg
≥50 kg
150 mg
The 150 mg and 300 mg solution for injection in pre-filled syringe and in pre-filled pen are not indicated for administration to paediatric patients with a weight <50 kg. Cosentyx may be available in other strengths and/or presentations depending on the individual treatment needs.
For all of the above indications, available data suggest that a clinical response is usually achieved within 16 weeks of treatment. Consideration should be given to discontinuing treatment in patients who have shown no response by 16 weeks of treatment. Some patients with an initial partial response may subsequently improve with continued treatment beyond 16 weeks.
Special populations
Elderly patients (aged 65 years and over)
No dose adjustment is required (see section 5.2).
Renal impairment / hepatic impairment
Cosentyx has not been studied in these patient populations. No dose recommendations can be made.
Paediatric population
The safety and efficacy of Cosentyx in children with plaque psoriasis and in the juvenile idiopathic arthritis (JIA) categories of ERA and JPsA below the age of 6 years have not been established.
The safety and efficacy of Cosentyx in children below the age of 18 years in other indications have not yet been established. No data are available.
Method of administration
Cosentyx is to be administered by subcutaneous injection. If possible, areas of the skin that show psoriasis should be avoided as injection sites. The syringe or the pen must not be shaken.
After proper training in subcutaneous injection technique, patients may self‑inject Cosentyx or be injected by a caregiver if a physician determines that this is appropriate. However, the physician should ensure appropriate follow‑up of patients. Patients or caregivers should be instructed to inject the full amount of Cosentyx according to the instructions provided in the package leaflet. Comprehensive instructions for administration are given in the package leaflet.
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
Clinically important, active infection, e.g. active tuberculosis (see section 4.4).
Traceability
In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded.
Infections
Secukinumab has the potential to increase the risk of infections. Serious infections have been observed in patients receiving secukinumab in the post-marketing setting. Caution should be exercised when considering the use of secukinumab in patients with a chronic infection or a history of recurrent infection.
Patients should be instructed to seek medical advice if signs or symptoms suggestive of an infection occur. If a patient develops a serious infection, the patient should be closely monitored and secukinumab should not be administered until the infection resolves.
In clinical studies, infections have been observed in patients receiving secukinumab (see section 4.8). Most of these were mild or moderate upper respiratory tract infections such as nasopharyngitis and did not require treatment discontinuation.
Related to the mechanism of action of secukinumab, non‑serious mucocutaneous candida infections were more frequently reported for secukinumab than placebo in the psoriasis clinical studies (3.55 per 100 patient years for secukinumab 300 mg versus 1.00 per 100 patient years for placebo) (see section 4.8).
Tuberculosis
Tuberculosis (active and/or latent reactivation) has been reported in patients treated with secukinumab. Patients should be evaluated for tuberculosis infection prior to initiating treatment with secukinumab. Secukinumab should not be given to patients with active tuberculosis (see section 4.3). In patients with latent tuberculosis, anti‑tuberculosis therapy should be considered prior to initiation of secukinumab as per clinical guidelines. Patients receiving secukinumab should be monitored for signs and symptoms of active tuberculosis.
Inflammatory bowel disease (including Crohn's disease and ulcerative colitis)
Cases of new or exacerbations of inflammatory bowel disease have been reported with secukinumab (see section 4.8). Secukinumab is not recommended in patients with inflammatory bowel disease. If a patient develops signs and symptoms of inflammatory bowel disease or experiences an exacerbation of pre-existing inflammatory bowel disease, secukinumab should be discontinued and appropriate medical management should be initiated.
Hypersensitivity reactions
Rare cases of anaphylactic reactions and angioedema have been observed in patients receiving secukinumab. If an anaphylactic reaction, angioedema or other serious allergic reactions occur, administration of secukinumab should be discontinued immediately and appropriate therapy initiated.
Latex‑sensitive individuals – Cosentyx 150 mg solution for injection in pre-filled syringe and 150 mg solution for injection in pre-filled pen only
The removable needle cap of Cosentyx 150 mg solution for injection in pre‑filled syringe and Cosentyx 150 mg solution for injection in pre-filled pen contains a derivative of natural rubber latex. No natural rubber latex has to date been detected in the removable needle cap. Nevertheless, the use of Cosentyx 150 mg solution for injection in pre‑filled syringe and Cosentyx 150 mg solution for injection in pre-filled pen in latex‑sensitive individuals has not been studied and there is therefore a potential risk of hypersensitivity reactions which cannot be completely ruled out.
Vaccinations
Live vaccines should not be given concurrently with secukinumab.
Patients receiving secukinumab may receive concurrent inactivated or non‑live vaccinations. In a study, after meningococcal and inactivated influenza vaccinations, a similar proportion of healthy volunteers treated with 150 mg of secukinumab and those treated with placebo were able to mount an adequate immune response of at least a 4‑fold increase in antibody titres to meningococcal and influenza vaccines. The data suggest that secukinumab does not suppress the humoral immune response to the meningococcal or influenza vaccines.
Prior to initiating therapy with Cosentyx, it is recommended that paediatric patients receive all age‑appropriate immunisations as per current immunisation guidelines.
Concomitant immunosuppressive therapy
In psoriasis studies, the safety and efficacy of secukinumab in combination with immunosuppressants, including biologics, or phototherapy have not been evaluated. Secukinumab was administered concomitantly with methotrexate (MTX), sulfasalazine and/or corticosteroids in arthritis studies (including in patients with psoriatic arthritis and ankylosing spondylitis). Caution should be exercised when considering concomitant use of other immunosuppressants and secukinumab (see also section 4.5).
Hepatitis B reactivation
Hepatitis B virus reactivation can occur in patients treated with secukinumab. In accordance with clinical guidelines for immunosuppresants, testing patients for HBV infection is to be considered before initiating treatment with secukinumab. Patients with evidence of positive HBV serology should be monitored for clinical and laboratory signs of HBV reactivation during secukinumab treatment. If reactivation of HBV occurs while on secukinumab, discontinuation of the treatment should be considered, and patients should be treated according to clinical guidelines.
Live vaccines should not be given concurrently with secukinumab (see also section 4.4).
In a study in adult subjects with plaque psoriasis, no interaction was observed between secukinumab and midazolam (CYP3A4 substrate).
No interaction was seen when secukinumab was administered concomitantly with methotrexate (MTX) and/or corticosteroids in arthritis studies (including in patients with psoriatic arthritis and axial spondyloarthritis).
Women of childbearing potential
Women of childbearing potential should use an effective method of contraception during treatment and for at least 20 weeks after treatment.
Pregnancy
There are no adequate data from the use of secukinumab in pregnant women.
Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity (see section 5.3). As a precautionary measure, it is preferable to avoid the use of Cosentyx during pregnancy.
Breast‑feeding
It is not known whether secukinumab is excreted in human milk. Immunoglobulins are excreted in human milk and it is not known if secukinumab is absorbed systemically after ingestion. Because of the potential for adverse reactions in nursing infants from secukinumab, a decision on whether to discontinue breast‑feeding during treatment and up to 20 weeks after treatment or to discontinue therapy with Cosentyx must be made taking into account the benefit of breast‑feeding to the child and the benefit of therapy to the woman.
Fertility
The effect of secukinumab on human fertility has not been evaluated. Animal studies do not indicate direct or indirect harmful effects with respect to fertility.
Cosentyx has no or negligible influence on the ability to drive and use machines.
Summary of the safety profile
The most frequently reported adverse reactions are upper respiratory tract infections (17.1%) (most frequently nasopharyngitis, rhinitis).
Tabulated list of adverse reactions
Adverse reactions from clinical studies and post-marketing reports (Table 3) are listed by MedDRA system organ class. Within each system organ class, the adverse reactions are ranked by frequency, with the most frequent reactions first. Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness. In addition, the corresponding frequency category for each adverse reaction is based on the following convention: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1 000 to <1/100); rare (≥1/10 000 to <1/1 000); very rare (<1/10 000); and not known (cannot be estimated from the available data).
Over 20 000 patients have been treated with secukinumab in blinded and open‑label clinical studies in various indications (plaque psoriasis, psoriatic arthritis, axial spondyloarthritis, hidradenitis suppurativa and other autoimmune conditions), representing 34 908 patient years of exposure. Of these, over 14 000 patients were exposed to secukinumab for at least one year. The safety profile of secukinumab is consistent across all indications.
Table 3 List of adverse reactions in clinical studies1) and post-marketing experience
System organ class
Frequency
Adverse reaction
Infections and infestations
Very common
Upper respiratory tract infections
Common
Oral herpes
Uncommon
Oral candidiasis
Otitis externa
Lower respiratory tract infections
Tinea pedis
Not known
Mucosal and cutaneous candidiasis (including oesophageal candidiasis)
Blood and lymphatic system disorders
Uncommon
Neutropenia
Immune system disorders
Rare
Anaphylactic reactions
Angioedema
Nervous system disorders
Common
Headache
Eye disorders
Uncommon
Conjunctivitis
Respiratory, thoracic and mediastinal disorders
Common
Rhinorrhoea
Gastrointestinal disorders
Common
Diarrhoea
Nausea
Uncommon
Inflammatory bowel disease
Skin and subcutaneous tissue disorders
Common
Eczema
Uncommon
Urticaria
Dyshidrotic eczema
Rare
Exfoliative dermatitis2)
Hypersensitivity vasculitis
Not known
Pyoderma gangrenosum
General disorders and administration site conditions
Common
Fatigue
1) Placebo‑controlled clinical studies (phase III) in plaque psoriasis, PsA, AS, nr-axSpA and HS patients exposed to 300 mg, 150 mg, 75 mg or placebo up to 12 weeks (psoriasis) or 16 weeks (PsA, AS, nr-axSpA and HS) treatment duration
2) Cases were reported in patients with psoriasis diagnosis
Description of selected adverse reactions
Infections
In the placebo‑controlled period of clinical studies in plaque psoriasis (a total of 1 382 patients treated with secukinumab and 694 patients treated with placebo for up to 12 weeks), infections were reported in 28.7% of patients treated with secukinumab compared with 18.9% of patients treated with placebo. The majority of infections consisted of non‑serious and mild to moderate upper respiratory tract infections, such as nasopharyngitis, which did not necessitate treatment discontinuation. There was an increase in mucosal or cutaneous candidiasis, consistent with the mechanism of action, but the cases were mild or moderate in severity, non‑serious, responsive to standard treatment and did not necessitate treatment discontinuation. Serious infections occurred in 0.14% of patients treated with secukinumab and in 0.3% of patients treated with placebo (see section 4.4).
Over the entire treatment period (a total of 3 430 patients treated with secukinumab for up to 52 weeks for the majority of patients), infections were reported in 47.5% of patients treated with secukinumab (0.9 per patient‑year of follow‑up). Serious infections were reported in 1.2% of patients treated with secukinumab (0.015 per patient‑year of follow‑up).
Infection rates observed in psoriatic arthritis and axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis) clinical studies were similar to those observed in the psoriasis studies.
Patients with hidradenitis suppurativa are more susceptible to infections. In the placebo‑controlled period of clinical studies in hidradenitis suppurativa (a total of 721 patients treated with secukinumab and 363 patients treated with placebo for up to 16 weeks), infections were numerically higher compared to those observed in the psoriasis studies (30.7% of patients treated with secukinumab compared with 31.7% in patients treated with placebo). Most of these were non‑serious, mild or moderate in severity and did not require treatment discontinuation or interruption.
Neutropenia
In psoriasis phase III clinical studies, neutropenia was more frequently observed with secukinumab than with placebo, but most cases were mild, transient and reversible. Neutropenia <1.0‑0.5x109/l (CTCAE grade 3) was reported in 18 out of 3 430 (0.5%) patients on secukinumab, with no dose dependence and no temporal relationship to infections in 15 out of 18 cases. There were no reported cases of more severe neutropenia. Non‑serious infections with usual response to standard care and not requiring discontinuation of secukinumab were reported in the remaining 3 cases.
The frequency of neutropenia in psoriatic arthritis, axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis) and hidradenitis suppurativa was similar to psoriasis.
Rare cases of neutropenia <0.5x109/l (CTCAE grade 4) were reported.
Immunogenicity
In psoriasis, psoriatic arthritis, axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis) and hidradenitis suppurativa clinical studies, less than 1% of patients treated with secukinumab developed antibodies to secukinumab up to 52 weeks of treatment. About half of the treatment‑emergent anti‑drug antibodies were neutralising, but this was not associated with loss of efficacy or pharmacokinetic abnormalities.
Paediatric population
Undesirable effects in paediatric patients from the age of 6 years with plaque psoriasis
The safety of secukinumab was assessed in two phase III studies in paediatric patients with plaque psoriasis. The first study (paediatric study 1) was a double-blind, placebo-controlled study of 162 patients from 6 to less than 18 years of age with severe plaque psoriasis. The second study (paediatric study 2) is an open-label study of 84 patients from 6 to less than 18 years of age with moderate to severe plaque psoriasis. The safety profile reported in these two studies was consistent with the safety profile reported in adult plaque psoriasis patients.
Undesirable effects in paediatric patients with JIA
The safety of secukinumab was also assessed in a phase III study in 86 juvenile idiopathic arthritis patients with ERA and JPsA from 2 to less than 18 years of age. The safety profile reported in this study was consistent with the safety profile reported in adult patients.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
Doses up to 30 mg/kg (approximately 2000 to 3000 mg) have been administered intravenously in clinical studies without dose‑limiting toxicity. In the event of overdose, it is recommended that the patient be monitored for any signs or symptoms of adverse reactions and appropriate symptomatic treatment be instituted immediately.
Ask anything about Cosentyx 150 mg solution for injection in pre-filled pen. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.
Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.
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