NICE guidance - Secukinumab for treating moderate to severe plaque psoriasis in children and young people

NICE guidance - Secukinumab for treating moderate to severe plaque psoriasis in children and young people

NICE state (1):

• Secukinumab is recommended as an option for treating plaque psoriasis in children and young people aged 6 to 17 years, only if:
  • the disease is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and
  • the disease has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated and
  • the company provides the drug according to the commercial arrangement
• stop secukinumab treatment at 12 weeks if the psoriasis has not responded adequately. An adequate response is defined as a 75% reduction in the PASI score (PASI 75) from when treatment started
• choose the least expensive treatment if patients (or their parents or carers) and their clinicians consider secukinumab to be one of a range of suitable treatments. Take into account availability of biosimilar products, administration costs, dosage, price per dose and commercial arrangements
• take into account how skin colour could affect the PASI score and make any appropriate clinical adjustments

Secukinumab for treating moderate to severe plaque psoriasis in children and young people

• is a human monoclonal antibody targeting IL-17A
• and blocks its interaction with the IL-17 receptor
• inhibition of the downstream effects of this proinflammatory cytokine thereby interferes with key psoriasis disease pathways while promoting normalization of immune function and skin histology
  • psoriasis is a systemic inflammatory disease associated with numerous comorbidities and a profound impact on patients' quality of life
  • evidence supports a fundamental role of the T-helper-17 (TH-17) pathway and its related interleukin-17 (IL-17) cytokine
  • identification of T-helper-17 (Th17) cells in psoriatic lesional skin implicated this T-cell population as a key contributor to the proinflammatory state of psoriasis
  • IL-17A receptors are expressed on the surface of keratinocytes, making these cells the primary target in psoriasis
    • upon IL-17A binding, there is increased keratinocyte expression of numerous chemokines (i.e. CCL20, CXCL1, and CXCL8), which play a role in recruiting inflammatory cells to lesional skin and stimulating the innate immune system
      • this complex interaction ultimately contributes to epidermal hyperproliferation and skin barrier dysfunction, important factors in psoriasis pathogenesis
      • effects of IL-17A are augmented by other inflammatory mediators, particularly, TNF-alpha
• recommended dosing for secukinumab differs for psoriasis as compared to psoriatic arthritis and ankylosing spondylitis
• Secukinumab - cautions and contraindications (2)
  • is contraindicated in patients with a hypersensitivity reaction to secukinumab or to any of its excipients
  • recommended to evaluate patients for tuberculosis infection prior to initiating treatment with secukinumab
  • should be avoided in patients with preexisting inflammatory bowel disease (IBD)
  • may increase the risk for infection, and live vaccines should not be given to patients treated with secukinumab

Reference:

• NICE (07 October 2021). Secukinumab for treating moderate to severe plaque psoriasis in children and young people
• Yang EJ, Beck KM, Liao W. Secukinumab in the treatment of psoriasis: patient selection and perspectives. Psoriasis (Auckl). 2018;8:75-82. Published 2018 Oct 17. doi:10.2147/PTT.S146004
• Frieder J, Kivelevitch D, Menter A. Secukinumab: a review of the anti-IL-17A biologic for the treatment of psoriasis. Ther Adv Chronic Dis. 2018;9(1):5-21. doi:10.1177/2040622317738910