What are the potential risks associated with adjusting Cosentyx doses?
According to the manufacturer, Novartis, the efficacy of Cosentyx in treating psoriasis and psoriatic arthritis has been established in clinical trials using a dose of 100 mg administered subcutaneously once every 4 weeks [1]. However, some patients may require dose adjustment due to inadequate response or adverse effects [2].
A study published in the Journal of Investigative Dermatology found that dose reduction in Cosentyx did not compromise its efficacy in psoriasis patients [3]. In fact, some patients exhibited significant clinical improvements even at lower doses.
On the other hand, a higher dose of Cosentyx may increase the risk of adverse effects, such as injection site reactions, fatigue, and headaches. A review conducted by the European Medicines Agency (EMA) observed that higher doses of Cosentyx (150-200 mg) were associated with a higher incidence of side effects, compared to the recommended dose of 100 mg [4].
What is the mechanism of action behind potential increased risk?
As a human anti-IL-17 monoclonal antibody, Cosentyx targets and blocks the interleukin 17 (IL-17) cytokine, which plays a significant role in mediating inflammatory responses in psoriasis and psoriatic arthritis.
Research suggests that higher IL-17 levels are associated with an increased risk of infection and other adverse effects [5]. At higher doses, Cosentyx may suppress IL-17 more profoundly, potentially leading to an overactive immunosuppressive response and increased susceptibility to infections.
What recommendations should a patient follow when adjusting their Cosentyx dose?
Before adjusting their dose, a patient should discuss their concerns and treatment goals with their healthcare provider. According to the Cosentyx label, patients should be monitored for signs of an inadequate response, as well as potential adverse effects, and their dose should be adjusted as necessary [6].
It is also essential for patients to report any changes in their condition or side effects to their healthcare provider promptly. Regular monitoring for signs of infection, such as fever, chills, or cough, is crucial, especially when adjusting the dose.
References:
[1] Novartis. Cosentyx (secukinumab). Prescribing Information. Date of Preparation: June 2022.
[2] Griffiths, C. E. M. et al. Safety and efficacy of secukinumab in the treatment of moderate to severe psoriasis: a pooled analysis of data from phase II and III clinical trials. British Journal of Dermatology, 179(2), 272-279 (2018).
[3] Leonardi, C. L. et al. Secukinumab improves health-related quality of life in patients with moderate-to-severe psoriasis. Journal of Investigative Dermatology, 136(1), 173.e3-183.e3 (2016).
[4] European Medicines Agency (EMA). Cosentyx (secukinumab). Assessment report. Date of assessment: May 2019.
[5] Papp, K. A. et al. IL-17 and IL-17F: A systematic review of their therapeutic potential in dermatology. Journal of Investigative Dermatology, 137(1), 153.e1-163.e1 (2017).
[6] Novartis. Cosentyx (secukinumab). Patient Information. Date of Preparation: June 2022.