Review Explains Value of Secukinumab for Children, Adolescents With Moderate to Severe Plaque Psoriasis

Secukinumab is a valuable addition to the limited treatment options available for children and adolescents with moderate to severe plaque psoriasis, according to new research published in Pediatric Drugs.

The monoclonal antibody is an effective and generally well-tolerated treatment for this group, and longer-term data will more definitively place the medication in relation to other biologic agents in pediatric plaque psoriasis management. It has demonstrated fast and durable skin clearance and improved health-related quality of life (QOL) in patients aged 6 to 18 years with moderate to severe plaque psoriasis.

“Compared with the expanding treatment options for adults with plaque psoriasis, the number of approved medications for pediatric plaque psoriasis is relatively low,” explained author Hannah Blair. “Subcutaneous secukinumab (Cosentyx) is one of several targeted biologic agents that have recently been approved for treating plaque psoriasis in pediatric patients.”

In her review, Blair summarized 2 phase 3 trials on the drug.

A randomized, double-blind, multicenter, placebo-controlled and active comparator-controlled trial focused on patients with severe plaque psoriasis. Patients were randomized to receive low-dose or high-dose secukinumab, subcutaneous (SC) etanercept, or placebo. Dosages were based on participant weight. Both doses of secukinumab and the placebo were administered at weeks 0 through 4 and then every 4 weeks. SC etanercept was administered once weekly.

At week 52, patients in the etanercept group discontinued treatment and entered the 16-week treatment-free follow-up period, while all patients in the secukinumab group entered the still ongoing extension treatment period.

This trial found secukinumab ro be highly efficacious for the treatment of severe plaque psoriasis in pediatric patients, with clinical efficacy seen as early as week 4 and similar response rates between those initially in the secukinumab group and those switched to the group later. Significantly improved health-related QOL was noted in participants in the high- and low-dose secukinumab groups compared with those in the placebo group and numerically more improved QOL compared with the etanercept group.

The second trial was an open-label, multicenter trial in patients with moderate to severe plaque psoriasis. Patients were randomized to receive low-dose or high-dose secukinumab. Rather than have an active placebo group, the researchers used data from placebo-controlled trials in adult and pediatric patients with plaque psoriasis. Similar to the other trial, both secukinumab groups saw greater improvements in psoriasis severity and QOL vs the historical placebo group.

“Secukinumab was generally well tolerated in pediatric patients with plaque psoriasis, with no new safety signals identified,” Blair said. “The safety profile in this population was consistent with that reported in adults with plaque psoriasis.”

A pooled analysis of both trials showed that the overall incidence of adverse events (AEs) up to week 52 was 74.5% with any low dose of secukinumab, 74.0% with any high dose of secukinumab, and 82.9% with etanercept. The corresponding rates of serious AEs were 7.1%, 6.0%, and 12.2%, respectively, with the most commonly reported AEs up to week 52 being nasopharyngitis and headache.

The tolerability profile of the drug in pediatric patients was consistent compared with adults with plaque psoriasis.

“In the pooled analysis, hypersensitivity reactions occurred in 10% of secukinumab recipients and 12% of etanercept recipients up to week 52,” she said. “Secukinumab is contraindicated in patients with a previous hypersensitivity reaction to secukinumab. Anaphylactic or other serious allergic reactions to secukinumab should be treated with appropriate therapy, and the drug should be discontinued.”

Targeted biologic agents offer multiple advantages that conventional systemic therapies cannot offer, such as less frequent dosing, enhanced efficacy, and reduced laboratory monitoring, she added.

“The convenience of less frequent dosing and the option of caregiver administration may result in better treatment adherence,” Blair concluded.

Reference

Blair HA. Secukinumab: a review in moderate to severe pediatric plaque psoriasis. Paediatr Drugs. 2021;23(6):601-608 doi:10.1007/s40272-021-00476-w