By David Borenstein MD, Executive Editor, theSpineCommunity.com
In January of 2016, the Food and Drug Administration approved Cosentyx® (secukinumab) for the treatment of psoriatic arthritis (PsA) and ankylosing spondylitis. Psoriatic spondylitis, an inflammatory spine disease, is a component of PsA responsive to Cosentyx therapy. The availability of Cosentyx allows another option for PsA patients with spine disease who have failed anti-TNF therapy.
Until the approval of Cosentyx, the only biologic therapy available for the treatment of PsA was anti-tumor necrosis factor antibodies directed against the protein directly or its receptor. Although this group of agents was effective in controlling the signs and symptoms of the illness, a significant proportion of PsA patients, a third or more, were unresponsive to this category of biologic therapy.
Cosentyx is an interleukin-17A (IL-17) inhibitor. IL-17 is a protein produced by immune cells in the setting of PsA. It is thought that this proinflammatory cytokine (a messenger between cells) plays an important role in the symptoms associated with PsA, including morning stiffness, limited spine motion, and overall fatigue.
An article recently published in the New England Journal of Medicine reported the benefit of Cosentyx in PsA patients. A total of 606 individuals participated in the 24 week study and were randomized to receive 10mg/kg of intravenous Cosentyx at weeks 0, 2 and 4 or placebo. Participants in the Cosentyx groups were further randomized to receive a follow up subcutaneous dose of 150 mg of Cosentyx or 75 mg of Cosentyx. At week 24, 50% of the patients who received 150 mg or 75 mg of Cosentyx experienced a 20% improvement or more in pain and function. Only 17% of the control group experienced a 20% improvement or more in pain and function. The study was continued with monthly injections for a total of a year. The benefits from Cosentyx were sustained throughout the yearlong study.
The safety profile of Cosentyx is similar to those of anti-TNF antibody therapy. Infections did occur more commonly in the Cosentyx group compared to placebo. No deaths occurred related to infections.
Reference: Mease PJ, McInnes IB, Kirkham B, et al. Secukinumab inhibition of interleukin-17A in patients with psoriatic arthritis. N Engl J Med 2015;373:13329-1339