What should clinicians consider first for elderly patients starting Cosentyx (secukinumab)?
Cosentyx (secukinumab) is an anti–IL-17A monoclonal antibody. In elderly patients, the main precautions are the same as for all patients, but clinicians should pay extra attention to infection risk and comorbidities that are more common with age.
Infection screening and monitoring (especially important in older adults)
Before starting Cosentyx, check whether the patient has any active infection and assess risk factors for infections, because blocking IL-17A can reduce the immune response needed to control certain infections. During treatment, elderly patients should be monitored for signs and symptoms of infection and evaluated promptly if symptoms occur.
Vaccines and exposure precautions
Elderly patients often have incomplete vaccination histories. Before initiating treatment, clinicians should review immunization status and plan vaccinations appropriately. Live vaccines generally should be avoided during biologic therapy; inactivated vaccines may be used but may not produce the same immune response. Patients should also avoid close contact with people who have contagious infections when possible.
Tuberculosis (TB) risk assessment
Cosentyx use requires TB screening before starting therapy and ongoing vigilance for TB symptoms during treatment, since immunomodulating biologics can increase the risk of reactivation of latent infections.
Considerations with other medications and comorbidities common in older adults
Elderly patients are more likely to be taking multiple medicines (including other immunosuppressants). Before and during treatment, clinicians should:
- Review the patient’s full medication list for overlapping immunosuppression.
- Reassess the risk/benefit if the patient has chronic conditions that can increase infection risk.
- Monitor for adverse events that may be harder to distinguish in older adults (fatigue, fever, worsening general health).
If an infection occurs while on Cosentyx, what should be done?
If an elderly patient develops signs of infection while receiving Cosentyx, clinicians should promptly evaluate the infection source and severity. Holding therapy may be necessary until the infection is addressed, based on clinical judgment and severity.
When to seek urgent medical care
Patients (or caregivers) should be instructed to seek urgent care for symptoms consistent with serious infection, such as persistent fever, shortness of breath, rapidly worsening skin pain or swelling, or severe systemic symptoms.
Source notes
If you want, share the patient’s indication (psoriasis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis) and key comorbidities (e.g., diabetes, prior TB, history of recurrent infections). Precautions can be tailored based on the exact clinical context.
Sources: None provided in the prompt.