Secukinumab for treating moderate to severe hidradenitis suppurativa

Secukinumab for treating moderate to severe hidradenitis suppurativa

Secukinumab is a human monoclonal immunoglobulin G1 kappa antibody that selectively binds to interleukin (IL) 17A:

• hidradenitis suppurativa (HS) is an inflammatory skin disease has imbalances in the T-helper 17 cell (Th17) axis that are similar to those in patients with psoriasis
• HS patients have high serum levels of the proinflammatory cytokine interleukin (IL) 17A, which leads to neutrophil recruitment and provides positive feedback to maintain the population of proinflammatory Th17 cells

Evidence suggests that, when given every 2 weeks, secukinumab was clinically effective at rapidly improving signs and symptoms of hidradenitis suppurativa with a favourable safety profile and with sustained response up to 52 weeks of treatment (1)

NICE states that secukinumab is recommended as an option for treating active moderate to severe hidradenitis suppurativa (acne inversa) in adults when it has not responded well enough to conventional systemic treatment, only if:

• adalimumab is not suitable, did not work or has stopped working
• the company provides secukinumab according to the commercial arrangement

• Assess response to secukinumab after the first 16 weeks of treatment, and only continue if there is clear evidence of a response, defined as:
  • a reduction of 25% or more in the total abscess and inflammatory nodule count, and
  • no increase in abscesses and draining fistulas

The NICE committee have stated:

"Current treatment for people with moderate to severe hidradenitis suppurativa when conventional systemic treatment (for example, oral antibiotics) has not worked well enough is adalimumab. For this evaluation, the company asked for secukinumab to be considered only for people who cannot have adalimumab or whose condition has not responded or has stopped responding to it. This does not include everyone who secukinumab is licensed for... evidence from 2 clinical trials shows that secukinumab generally improves symptoms of moderate to severe hidradenitis suppurativa more than placebo in the people the company has asked for it to be considered for..."

References:

1. Kimball AB et al. Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): week 16 and week 52 results of two identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials. Lancet. 2023 Mar 4;401(10378):747-761.
2. NICE (December 2023). Secukinumab for treating moderate to severe hidradenitis suppurativa.