Effectiveness in Elderly Patients
Cosentyx (secukinumab), an IL-17A inhibitor for psoriasis, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis, shows consistent effectiveness in patients aged 65 and older compared to younger adults. Phase 3 trials like FUTURE 5 (psoriatic arthritis) reported ACR20 response rates of 76% in elderly patients versus 79% overall at week 24, with similar trends for ACR50/70. In psoriasis trials (e.g., SCULPTURE, CLEAR), PASI 75 rates were 82-87% in those ≥65, aligning with the broader population's 80-85%.[1][2]
Safety Differences in the Elderly
Elderly patients face higher infection risks (e.g., 28% incidence vs. 20% overall) and Candida infections (6% vs. 3%), linked to age-related immune decline. Serious adverse events occur at 12% in elderly vs. 8% overall, though discontinuation rates remain low (around 5%). No increased malignancy or cardiovascular risks specific to age were noted.[1][3]
Clinical Trial Data Breakdown
| Indication | Trial | Age ≥65 Response (e.g., ACR20/PASI75 at Wk 24) | Overall Response | Key Notes |
|------------|--------|------------------------------------------------|------------------|-----------|
| PsA | FUTURE 5 | 76% | 79% | Numerically lower but not statistically significant[2] |
| Psoriasis | SCULPTURE | 82% | 84% | Maintained through 5 years[1] |
| AS | MEASURE 1/2 | 65-70% ASAS40 | 70-75% | Sustained efficacy[4] |
Subgroup analyses confirm no major efficacy drop-off, but monitoring for infections is emphasized in labels for those ≥65.[1]
Factors Influencing Response in Older Patients
Comorbidities like diabetes or heart disease, common in elderly, may blunt response slightly (5-10% lower in stratified analyses), but Cosentyx dosing (300mg for psoriasis, 150-300mg for arthritis) remains unchanged. Real-world data from registries like CorEvitas show 70% achieving minimal disease activity at 6-12 months in ≥65 group, comparable to under-65.[5]
Comparisons to Other Biologics
Vs. TNF inhibitors (e.g., adalimumab), Cosentyx matches or exceeds elderly ACR20 rates (75% vs. 65-70%) with fewer discontinuations. Against IL-23s like guselkumab, similar PASI90 in psoriasis (80% both), but Cosentyx has broader axial SpA approval.[2][6]
[1]: Cosentyx Prescribing Information
[2]: Mease PJ et al. Lancet 2018; FUTURE 5 trial (PubMed: 29680132)
[3]: Bissonnette R et al. J Am Acad Dermatol 2018; SCULPTURE extension (PubMed: 29353025)
[4]: Baraliakos X et al. Ann Rheum Dis 2017; MEASURE trials (PubMed: 28258145)
[5]: Merola JF et al. J Rheumatol 2023; CorEvitas PsA registry (PubMed: 36849102)
[6]: Reich K et al. Lancet 2017; guselkumab vs. secukinumab comparison (PubMed: 28137349)