Secukinumab for children and adolescents with enthesitis-related arthritis and psoriatic arthritis: lessons from treatment in adults and the way forward

ABSTRACT

Introduction

Targeting IL-17A using Secukinumab, a humanized monoclonal immunoglobulin G1 (IgG1)/κ against IL-17A is a therapeutic option for immune-mediated disorders such as psoriasis and ankylosing spondylitis. The US Food and Drug Administration and the European Medicines Agency have approved it for the treatment of moderate to severe plaque psoriasis, active psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondylarthritis. Recently it has also been approved for use in children with severe plaque psoriasis, active psoriatic arthritis, and enthesitis-related arthritis.

Areas covered

This review focuses on the role of Secukinumab in the management of children and adolescents with enthesitis-related arthritis and psoriatic arthritis. We discuss the salient findings of pivotal RCTs and other studies supporting the use of Secukinumab in adults and children, in particular, focusing on its safety and efficacy.

Expert opinion

Secukinumab is a therapeutic target for psoriasis, psoriatic arthritis, and spondyloarthropathies in both adults and children. No major safety signals are observed with its use in short-term follow-up. Thus far, Secukinumab has not been found to significantly increase the risk of tuberculosis (TB).

KEYWORDS:

• IL-17 inhibitor
• Secukinumab
• pediatric
• ERA
• psoriatic arthritis

Article highlights

• Aberrations in Interleukin 23/17 immunological pathway lead to various immune-mediated inflammatory disorders such as Psoriasis (PsO), psoriatic arthritis (PsA) and enthesitis-related arthritis (ERA).

• Targeting this pathway using IL-17 blockers such as Secukinumab has proven its efficacy in the management of these disorders.

• Secukinumab in its approved doses (administered as weekly subcutaneous injections for initial 5 weeks followed by every 4 weekly; 75mg for children 15- 50 kg and 150mg for those weighing more than 50 kg) seems to be effective and safe for management of children with PsA and ERA.

Declaration of interest

AV Ramanan participated in the study of secukinimab in ERA/JPsA and author of the paper. COI declaration- Speaker fees/Honoraria/Consultancy: Novartis, Abbvie, Eli Lilly, Pfizer, Roche, SOBI, Astra Zeneca and UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Pediatric Rheumatology European Society for supporting NK Bagri for pursuing a clinical fellowship through PReS EMERGE fellowship program at the Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK under the mentorship of AV Ramanan.

Author contributions

NK Bagri: concept, design, literature review, drafting and editing of the manuscript. H King: literature review, drafting and editing of the manuscript. AV Ramanan: concept, design, reviewed the draft for intellectual comments. All authors approved the final version of the draft.

Additional information

Funding

This paper was not funded.