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

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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:

Last edited 10/2021 and last reviewed 10/2021

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