Hidradenitis Suppurativa Treatment with Secukinumab

Medical Necessity Rationale

Cosentyx is FDA-approved for "active moderate to severe HS (acne inversa) in adults with an inadequate response to conventional systemic HS therapy" 1, 2
The recommended dosage for HS is 300 mg administered by subcutaneous injection at Weeks 0, 1, 2, 3, and 4, followed by every 4 weeks thereafter, with potential increase to every 2 weeks if inadequate response 3

Oral antibiotics, such as Tetracyclines (doxycycline, minocycline) or clindamycin/rifampin combination, are recommended as first-line therapy for hidradenitis suppurativa 4
Topical antibiotics, such as Clindamycin 1% solution, are also recommended as first-line therapy for hidradenitis suppurativa 4
Biologics, including Adalimumab and Secukinumab, are recommended for moderate-to-severe HS with inadequate response to conventional therapy 4

Baseline tuberculosis screening (PPD) is recommended before initiating secukinumab therapy, and patients should be monitored for signs of infection 5
Patients with a history of inflammatory bowel disease should be assessed before initiating secukinumab therapy, as it is a contraindication 3, 5
The most common adverse events associated with secukinumab include upper respiratory tract infections, oral herpes, headache, rhinorrhea, diarrhea, nausea, and fatigue 5
Serious infections, including mucosal and cutaneous candidiasis, have been reported in patients treated with secukinumab 5

Secukinumab should not be used in patients with active inflammatory bowel disease, as new cases or exacerbations have been reported 3
Secukinumab increases the risk of infections, and serious infections have been observed 5
Latent TB screening is required before initiation of secukinumab therapy 3
Neutropenia has been reported more frequently with secukinumab than placebo, though most cases are mild, transient, and reversible 5
Hypersensitivity reactions, including rare cases of anaphylactic reactions, have been reported with secukinumab 5

The National Comprehensive Cancer Network recommends reviewing concomitant medications, such as opioids, anticholinergics, 5-HT3 antagonists, and vinca alkaloids, if a patient on secukinumab experiences constipation 6, 7
The National Comprehensive Cancer Network suggests assessing for metabolic causes, including hypercalcemia, hypokalemia, and hypothyroidism, in patients experiencing constipation while on secukinumab 8
Nausea is a documented adverse effect of secukinumab, according to the Journal of the National Comprehensive Cancer Network 6