Annex I Summary of Product Characteristics
Annex I Summary of Product Characteristics
Annex I Summary of Product Characteristics
1
This medicinal product is subject to additional monitoring. This will allow quick identification of
new safety information. Healthcare professionals are asked to report any suspected adverse reactions.
See section 4.8 for how to report adverse reactions.
Each vial of powder contains 150 mg secukinumab*. After reconstitution, 1 ml of solution contains
150 mg secukinumab.
3. PHARMACEUTICAL FORM
4. CLINICAL PARTICULARS
Cosentyx is indicated for the treatment of moderate to severe plaque psoriasis in adults who are
candidates for systemic therapy.
Cosentyx is intended for use under the guidance and supervision of a physician experienced in the
diagnosis and treatment of psoriasis.
Posology
The recommended dose is 300 mg of secukinumab by subcutaneous injection with initial dosing at
Weeks 0, 1, 2 and 3, followed by monthly maintenance dosing starting at Week 4. Each 300 mg dose
is given as two subcutaneous injections of 150 mg.
Consideration should be given to discontinuing treatment in patients who have shown no response up
to 16 weeks of treatment. Some patients with initially partial response may subsequently improve with
continued treatment beyond 16 weeks.
2
Paediatric population
The safety and efficacy of Cosentyx in children below the age of 18 years have not yet been
established. No data are available.
Method of administration
Cosentyx is to be administered by subcutaneous injection. If possible, areas of the skin that show
psoriasis should be avoided as injection sites. The powder for solution for injection must be
reconstituted before use. For instructions on reconstitution of the medicinal product before
administration, see section 6.6 and the Instructions for Use in the package leaflet.
4.3 Contraindications
Severe hypersensitivity reactions to the active substance or to any of the excipients listed in
section 6.1.
Clinically important, active infection (e.g. active tuberculosis; see section 4.4).
Infections
Cosentyx has the potential to increase the risk of infections. In clinical studies, infections have been
observed in patients receiving Cosentyx (see section 4.8). Most of these were mild or moderate upper
respiratory tract infections such as nasopharyngitis and did not require treatment discontinuation.
Related to the mechanism of action of Cosentyx, non-serious mucocutaneous candida infections were
more frequently reported for secukinumab than placebo in the psoriasis clinical studies (3.55 per
100 patient years for secukinumab 300 mg versus 1.00 per 100 patient years for placebo) (see
section 4.8).
Caution should be exercised when considering the use of Cosentyx in patients with a chronic infection
or a history of recurrent infection.
Patients should be instructed to seek medical advice if signs or symptoms suggestive of an infection
occur. If a patient develops a serious infection, the patient should be closely monitored and Cosentyx
should not be administered until the infection resolves.
No increased susceptibility to tuberculosis was reported from clinical studies. However, Cosentyx
should not be given to patients with active tuberculosis. Anti-tuberculosis therapy should be
considered prior to initiation of Cosentyx in patients with latent tuberculosis.
Crohn’s disease
Caution should be exercised when prescribing Cosentyx to patients with Crohn’s disease as
exacerbations of Crohn’s disease, in some cases serious, were observed in clinical studies in both
Cosentyx and placebo groups. Patients who are treated with Cosentyx and have Crohn’s disease
should be followed closely.
Hypersensitivity reactions
Vaccinations
3
Patients receiving Cosentyx may receive concurrent inactivated or non-live vaccinations. In a study,
after meningococcal and inactivated influenza vaccinations, a similar proportion of healthy volunteers
treated with 150 mg of secukinumab and those treated with placebo were able to mount an adequate
immune response of at least a 4-fold increase in antibody titres to meningococcal and influenza
vaccines. The data suggest that Cosentyx does not suppress the humoral immune response to the
meningococcal or influenza vaccines.
In psoriasis studies, the safety and efficacy of Cosentyx in combination with immunosuppressants,
including biologics, or phototherapy have not been evaluated (see also section 4.5).
4.5 Interaction with other medicinal products and other forms of interaction
Live vaccines should not be given concurrently with Cosentyx (see also section 4.4).
No interaction studies have been performed in humans. There is no direct evidence for the role of
IL-17A in the expression of CYP450 enzymes. The formation of some CYP450 enzymes is
suppressed by increased levels of cytokines during chronic inflammation. Thus, anti-inflammatory
treatments, such as with the IL-17A inhibitor secukinumab, may result in normalisation of CYP450
levels with accompanying lower exposure of CYP450-metabolised co-medications. Therefore, a
clinically relevant effect on CYP450 substrates with a narrow therapeutic index, where the dose is
individually adjusted (e.g. warfarin) cannot be excluded. On initiation of secukinumab therapy in
patients being treated with these types of medicinal products, therapeutic monitoring should be
considered.
Women of childbearing potential should use an effective method of contraception during treatment
and for at least 20 weeks after treatment.
Pregnancy
There are no adequate data from the use of secukinumab in pregnant women. Animal studies do not
indicate direct or indirect harmful effects with respect to pregnancy, embryonic/foetal development,
parturition or postnatal development (see section 5.3). As a precautionary measure, it is preferable to
avoid the use of Cosentyx in pregnancy.
Breast-feeding
It is not known whether secukinumab is excreted in human milk. Immunoglobulins are excreted in
human milk and it is not known if secukinumab is absorbed systemically after ingestion. Because of
the potential for adverse reactions in nursing infants from secukinumab, a decision on whether to
discontinue breast-feeding during treatment and up to 20 weeks after treatment or to discontinue
therapy with Cosentyx must be made taking into account the benefit of breast-feeding to the child and
the benefit of Cosentyx therapy to the woman.
Fertility
The effect of secukinumab on human fertility has not been evaluated. Animal studies do not indicate
direct or indirect harmful effects with respect to fertility (see section 5.3).
4
4.7 Effects on ability to drive and use machines
Cosentyx has no or negligible influence on the ability to drive and use machines.
A total of 4,498 patients have been treated with Cosentyx in blinded and open-label clinical studies in
various indications (plaque psoriasis and other autoimmune conditions). Of these, 1,900 patients were
exposed to Cosentyx for at least one year, representing 3,588 patient years of exposure.
Four placebo-controlled phase III studies in plaque psoriasis were pooled to evaluate the safety of
Cosentyx in comparison to placebo up to 12 weeks after treatment initiation. In total, 2,076 patients
were evaluated (692 patients on 150 mg, 690 patients on 300 mg and 694 patients on placebo).
The most frequently reported adverse drug reactions (ADRs) were upper respiratory tract infections
(most frequently nasopharyngitis, rhinitis). Most of the reactions were mild or moderate in severity.
ADRs from clinical studies (Table 1) are listed by MedDRA system organ class. Within each system
organ class, the ADRs are ranked by frequency, with the most frequent reactions first. Within each
frequency grouping, adverse drug reactions are presented in order of decreasing seriousness. In
addition, the corresponding frequency category for each adverse drug reaction is based on the
following convention: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to
<1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000).
5
Description of selected adverse reactions
Infections
In the placebo-controlled period of clinical studies in plaque psoriasis (a total of 1,382 patients treated
with Cosentyx and 694 patients treated with placebo for up to 12 weeks), infections were reported in
28.7% of patients treated with Cosentyx compared with 18.9% of patients treated with placebo. The
majority of infections consisted of non-serious and mild to moderate upper respiratory tract infections,
such as nasopharyngitis, which did not necessitate treatment discontinuation. There was an increase in
mucosal or cutaneous candidiasis, consistent with the mechanism of action, but the cases were mild or
moderate in severity, non-serious, responsive to standard treatment and did not necessitate treatment
discontinuation. Serious infections occurred in 0.14% of patients treated with Cosentyx and in 0.3% of
patients treated with placebo (see section 4.4).
Over the entire treatment period (a total of 3,430 patients treated with Cosentyx for up to 52 weeks for
the majority of patients), infections were reported in 47.5% of patients treated with Cosentyx (0.9 per
patient-year of follow-up). Serious infections were reported in 1.2% of patients treated with Cosentyx
(0.015 per patient-year of follow-up).
Neutropenia
Neutropenia was more frequently observed with secukinumab than with placebo, but most cases were
mild, transient and reversible. Neutropenia <1.0-0.5x109/l (CTCAE Grade 3) was reported in 18 out of
3,430 (0.5%) patients on secukinumab, with no dose dependence and no temporal relationship to
infections in 15 out of 18 cases. There were no reported cases of more severe neutropenia. Non-serious
infections with usual response to standard care and not requiring discontinuation of Cosentyx were
reported in the remaining 3 cases.
Hypersensitivity reactions
In clinical studies, urticaria and one case of anaphylactic reaction to Cosentyx were observed (see also
section 4.4).
Immunogenicity
Less than 1% of patients treated with Cosentyx developed antibodies to secukinumab up to 52 weeks
of treatment. About half of the treatment-emergent anti-drug antibodies were neutralising, but this was
not associated with loss of efficacy or pharmacokinetic abnormalities.
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare
professionals are asked to report any suspected adverse reactions via the national reporting system
listed in Appendix V.
4.9 Overdose
Doses up to 30 mg/kg (approximately 2000 to 3000 mg) have been administered intravenously in
clinical studies without dose-limiting toxicity. In the event of overdose, it is recommended that the
patient be monitored for any signs or symptoms of adverse reactions and appropriate symptomatic
treatment be instituted immediately.
6
5. PHARMACOLOGICAL PROPERTIES
Mechanism of action
Secukinumab is a fully human IgG1/κ monoclonal antibody that selectively binds to and neutralises
the proinflammatory cytokine interleukin-17A (IL-17A). Secukinumab works by targeting IL-17A and
inhibiting its interaction with the IL-17 receptor, which is expressed on various cell types including
keratinocytes. As a result, secukinumab inhibits the release of proinflammatory cytokines, chemokines
and mediators of tissue damage and reduces IL-17A-mediated contributions to autoimmune and
inflammatory diseases. Clinically relevant levels of secukinumab reach the skin and reduce local
inflammatory markers. As a direct consequence treatment with secukinumab reduces erythema,
induration and desquamation present in plaque psoriasis lesions.
IL-17A is a naturally occurring cytokine that is involved in normal inflammatory and immune
responses. IL-17A plays a key role in the pathogenesis of plaque psoriasis and is up-regulated in
lesional skin in contrast to non-lesional skin of plaque psoriasis patients.
Pharmacodynamic effects
Serum levels of total IL-17A (free and secukinumab-bound IL-17A) are initially increased in patients
receiving secukinumab. This is followed by a slow decrease due to reduced clearance of
secukinumab-bound IL-17A, indicating that secukinumab selectively captures free IL-17A, which
plays a key role in the pathogenesis of plaque psoriasis.
The safety and efficacy of Cosentyx were assessed in four randomised, double-blind,
placebo-controlled phase III studies in patients with moderate to severe plaque psoriasis who were
candidates for phototherapy or systemic therapy [ERASURE, FIXTURE, FEATURE, JUNCTURE].
The efficacy and safety of Cosentyx 150 mg and 300 mg were evaluated versus either placebo or
etanercept. In addition, one study assessed a chronic treatment regimen versus a “retreatment as
needed” regimen [SCULPTURE].
Of the 2,403 patients who were included in the placebo-controlled studies, 79% were biologic-naive,
45% were non-biologic failures and 8% were biologic failures (6% were anti-TNF failures, and 2%
were anti-p40 failures). Approximately 15 to 25% of patients in phase III studies had psoriatic arthritis
(PsA) at baseline.
Psoriasis Study 1 (ERASURE) evaluated 738 patients. Patients randomised to Cosentyx received
150 mg or 300 mg doses at Weeks 0, 1, 2, and 3, followed by the same dose every month starting at
Week 4. Psoriasis Study 2 (FIXTURE) evaluated 1,306 patients. Patients randomised to Cosentyx
received 150 mg or 300 mg doses at Weeks 0, 1, 2, and 3, followed by the same dose every month
starting at Week 4. Patients randomised to etanercept received 50 mg doses twice per week for
12 weeks followed by 50 mg every week. In both Study 1 and Study 2, patients randomised to receive
placebo who were non-responders at Week 12 then crossed over to receive Cosentyx (either 150 mg or
300 mg) at Weeks 12, 13, 14, and 15, followed by the same dose every month starting at Week 16. All
patients were followed for up to 52 weeks following first administration of study treatment.
7
Psoriasis Study 3 (FEATURE) evaluated 177 patients using a pre-filled syringe compared with
placebo after 12 weeks of treatment to assess the safety, tolerability, and usability of Cosentyx
self-administration via the pre-filled syringe. Psoriasis Study 4 (JUNCTURE) evaluated 182 patients
using a pre-filled pen compared with placebo after 12 weeks of treatment to assess the safety,
tolerability, and usability of Cosentyx self-administration via the pre-filled pen. In both Study 3 and
Study 4, patients randomised to Cosentyx received 150 mg or 300 mg doses at Weeks 0, 1, 2, and 3,
followed by the same dose every month starting at Week 4. Patients were also randomised to receive
placebo at Weeks 0, 1, 2, and 3, followed by the same dose every month starting at Week 4.
Psoriasis Study 5 (SCULPTURE) evaluated 966 patients. All patients received Cosentyx 150 mg or
300 mg doses at Weeks 0, 1, 2, 3, 4, 8 and 12 and then were randomised to receive either a
maintenance regimen of the same dose every month starting at Week 12 or a “retreatment as needed”
regimen of the same dose. Patients randomised to “retreatment as needed” did not achieve adequate
maintenance of response and therefore a fixed monthly maintenance regimen is recommended.
The co-primary endpoints in the placebo and active-controlled studies were the proportion of patients
who achieved a PASI 75 response and IGA mod 2011 “clear” or “almost clear” response versus
placebo at Week 12 (see Tables 2 and 3). The 300 mg dose provided improved skin clearance
particularly for “clear” or “almost clear” skin across the efficacy endpoints of PASI 90, PASI 100, and
IGA mod 2011 0 or 1 response across all studies with peak effects seen at Week 16, therefore this dose
is recommended.
Table 2 Summary of PASI 50/75/90/100 & IGA⃰ mod 2011 “clear” or “almost clear” clinical
response in Psoriasis Studies 1, 3 and 4 (ERASURE, FEATURE and JUNCTURE)
8
Study 4
Number of patients 61 60 60 - - - -
PASI 50 response n (%) 5 (8.2%) 48 58 - - - -
(80.0%) (96.7%)
PASI 75 response n (%) 2 (3.3%) 43 52 - - - -
(71.7%)** (86.7%)**
PASI 90 response n (%) 0 (0.0%) 24 33 - - - -
(40.0%) (55.0%)
PASI 100 response n(%) 0 (0.0%) 10 16 - - - -
(16.7%) (26.7%)
IGA mod 2011 “clear” or 0 (0.0%) 32 44 - - - -
“almost clear” response (53.3%)** (73.3%)**
n (%)
* The IGA mod 2011 is a 5-category scale including “0 = clear”, “1 = almost clear”, “2 = mild”, “3 =
moderate” or “4 = severe”, indicating the physician’s overall assessment of the psoriasis severity focusing
on induration, erythema and scaling. Treatment success of “clear” or “almost clear” consisted of no signs of
psoriasis or normal to pink colouration of lesions, no thickening of the plaque and none to minimal focal
scaling.
** p values versus placebo and adjusted for multiplicity: p<0.0001.
Cosentyx was associated with a fast onset of efficacy with a 50% reduction in mean PASI by Week 3
for the 300 mg dose.
9
Figure 1 Time course of percentage change from baseline of mean PASI score in Study 1
(ERASURE)
Weeks of treatment
n = number of patients evaluable
Forty percent of the participants in Studies 1 and 2 completed the Psoriasis Symptom Diary©. For the
participants completing the diary in each of these studies, statistically significant improvements at
Week 12 from baseline compared to placebo in patient-reported signs and symptoms of itching, pain
and scaling were demonstrated.
Paediatric population
The European Medicines Agency has waived the obligation to submit the results of studies with
Cosentyx in plaque psoriasis in paediatric patients aged from birth to less than 6 years (see section 4.2
for information on paediatric use).
The European Medicines Agency has deferred the obligation to submit the results of studies with
Cosentyx in plaque psoriasis in paediatric patients aged from 6 years to less than 18 years (see
section 4.2 for information on paediatric use).
Absorption
Based on population pharmacokinetic analysis, following a single subcutaneous dose of either 150 mg
or 300 mg in plaque psoriasis patients, secukinumab reached peak serum concentrations of
13.7±4.8 µg/ml or 27.3±9.5 µg/ml, respectively, between 5 and 6 days post dose.
10
After initial weekly dosing during the first month, time to reach the maximum concentration was
between 31 and 34 days based on population pharmacokinetic analysis.
On the basis of simulated data, peak concentrations at steady-state (Cmax,ss) following subcutaneous
administration of 150 mg or 300 mg were 27.6 µg/ml and 55.2 µg/ml, respectively. Population
pharmacokinetic analysis suggests that steady-state is reached after 20 weeks with monthly dosing
regimens.
Compared with exposure after a single dose, the population pharmacokinetic analysis showed that
patients exhibited a 2-fold increase in peak serum concentrations and area under the curve (AUC)
following repeated monthly dosing during maintenance.
Population pharmacokinetic analysis showed that secukinumab was absorbed with an average absolute
bioavailability of 73% in patients with plaque psoriasis. Across studies, absolute bioavailabilities in
the range between 60 and 77% were calculated.
Distribution
The mean volume of distribution during the terminal phase (Vz) following single intravenous
administration ranged from 7.10 to 8.60 litres in plaque psoriasis patients, suggesting that
secukinumab undergoes limited distribution to peripheral compartments.
Biotransformation
The majority of IgG elimination occurs via intracellular catabolism, following fluid-phase or receptor
mediated endocytosis.
Elimination
Mean systemic clearance (CL) following a single intravenous administration to patients with plaque
psoriasis ranged from 0.13 to 0.36 l/day. In a population pharmacokinetic analysis, the mean systemic
clearance (CL) was 0.19 l/day in plaque psoriasis patients. The CL was not impacted by gender.
Clearance was dose- and time-independent.
The mean elimination half-life, as estimated from population pharmacokinetic analysis, was 27 days in
plaque psoriasis patients, ranging from 18 to 46 days across psoriasis studies with intravenous
administration.
Linearity/non-linearity
The single and multiple dose pharmacokinetics of secukinumab in plaque psoriasis patients were
determined in several studies with intravenous doses ranging from 1x 0.3 mg/kg to 3x 10 mg/kg and
with subcutaneous doses ranging from 1x 25 mg to multiple doses of 300 mg. Exposure was dose
proportional across all dosing regimens.
Elderly patients
Of the 3,430 plaque psoriasis patients exposed to Cosentyx in clinical studies, a total of 230 were
65 years of age or older and 32 patients were 75 years of age or older.
Based on population pharmacokinetic analysis with a limited number of elderly patients (n=71 for age
≥65 years and n=7 for age ≥75 years), clearance in elderly patients and patients less than 65 years of
age was similar.
11
Patients with renal or hepatic impairment
No pharmacokinetic data are available in patients with renal or hepatic impairment. The renal
elimination of intact Cosentyx, an IgG monoclonal antibody, is expected to be low and of minor
importance. IgGs are mainly eliminated via catabolism and hepatic impairment is not expected to
influence clearance of Cosentyx.
Non-clinical data revealed no special risks for humans based on tissue cross-reactivity testing, safety
pharmacology, repeated dose and reproductive toxicity studies performed with secukinumab or a
murine anti-murine IL-17A antibody.
Since secukinumab binds to cynomolgus monkey and human IL-17A, its safety was studied in the
cynomolgus monkey. No undesirable effects of secukinumab were seen following subcutaneous
administration to cynomolgus monkeys for up to 13 weeks and intravenous administration up to
26 weeks (including pharmacokinetic, pharmacodynamic, immunogenicity and immunotoxicity (e.g.
T-cell dependent antibody response and NK cell activity) evaluations). The average serum
concentrations observed in monkeys after 13 weekly subcutaneous doses of 150 mg/kg were
considerably higher than the predicted average serum concentration expected in psoriatic patients at
the highest clinical dose. Antibodies to secukinumab were detected in only one of the exposed
animals. No non-specific tissue cross-reactivity was observed when secukinumab was applied to
normal human tissue.
Animal studies have not been conducted to evaluate the carcinogenic potential of secukinumab.
No undesirable effects of a murine anti-murine IL-17A antibody were seen in fertility and early
embryonic development and pre-and postnatal development studies in mice. The high dose used in
these studies was in excess of the maximum effective dose in terms of IL-17A suppression and activity
(see section 4.6).
6. PHARMACEUTICAL PARTICULARS
Sucrose
L-histidine
L-histidine hydrochloride monohydrate
Polysorbate 80
6.2 Incompatibilities
This medicinal product must not be mixed with other medicinal products except those mentioned in
section 6.6.
3 years
12
After reconstitution
Chemical and physical in-use stability has been demonstrated for 24 hours at 2ºC to 8ºC.
From a microbiological point of view, unless the method of reconstitution precludes the risk of
microbial contamination, the product should be used immediately.
If not used immediately, in-use storage times and conditions are the responsibility of the user.
Cosentyx is supplied in a colourless glass vial with a grey coated rubber stopper and aluminium cap
with a white flip-off component containing 150 mg of secukinumab.
The single-use vial contains 150 mg secukinumab for reconstitution with sterile water for injections.
The resulting solution should be clear and colourless to slightly yellow. Do not use if the lyophilised
powder has not fully dissolved or if the liquid contains easily visible particles, is cloudy or is distinctly
brown. Detailed instructions for use are provided in the package leaflet.
Any unused medicinal product or waste material should be disposed of in accordance with local
requirements.
EU/1/14/980/001
Detailed information on this medicinal product is available on the website of the European Medicines
Agency http://www.ema.europa.eu.
13
This medicinal product is subject to additional monitoring. This will allow quick identification of
new safety information. Healthcare professionals are asked to report any suspected adverse reactions.
See section 4.8 for how to report adverse reactions.
3. PHARMACEUTICAL FORM
4. CLINICAL PARTICULARS
Cosentyx is indicated for the treatment of moderate to severe plaque psoriasis in adults who are
candidates for systemic therapy.
Cosentyx is intended for use under the guidance and supervision of a physician experienced in the
diagnosis and treatment of psoriasis.
Posology
The recommended dose is 300 mg of secukinumab by subcutaneous injection with initial dosing at
Weeks 0, 1, 2 and 3, followed by monthly maintenance dosing starting at Week 4. Each 300 mg dose
is given as two subcutaneous injections of 150 mg.
Consideration should be given to discontinuing treatment in patients who have shown no response up
to 16 weeks of treatment. Some patients with initially partial response may subsequently improve with
continued treatment beyond 16 weeks.
14
Paediatric population
The safety and efficacy of Cosentyx in children below the age of 18 years have not yet been
established. No data are available.
Method of administration
Cosentyx is to be administered by subcutaneous injection. If possible, areas of the skin that show
psoriasis should be avoided as injection sites.
After proper training in subcutaneous injection technique, patients may self-inject Cosentyx if a
physician determines that this is appropriate. However, the physician should ensure appropriate
follow-up of patients. Patients should be instructed to inject the full amount of Cosentyx according to
the instructions provided in the package leaflet. Comprehensive instructions for administration are
given in the package leaflet.
4.3 Contraindications
Severe hypersensitivity reactions to the active substance or to any of the excipients listed in
section 6.1.
Clinically important, active infection (e.g. active tuberculosis; see section 4.4).
Infections
Cosentyx has the potential to increase the risk of infections. In clinical studies, infections have been
observed in patients receiving Cosentyx (see section 4.8). Most of these were mild or moderate upper
respiratory tract infections such as nasopharyngitis and did not require treatment discontinuation.
Related to the mechanism of action of Cosentyx, non-serious mucocutaneous candida infections were
more frequently reported for secukinumab than placebo in the psoriasis clinical studies (3.55 per
100 patient years for secukinumab 300 mg versus 1.00 per 100 patient years for placebo) (see
section 4.8).
Caution should be exercised when considering the use of Cosentyx in patients with a chronic infection
or a history of recurrent infection.
Patients should be instructed to seek medical advice if signs or symptoms suggestive of an infection
occur. If a patient develops a serious infection, the patient should be closely monitored and Cosentyx
should not be administered until the infection resolves.
No increased susceptibility to tuberculosis was reported from clinical studies. However, Cosentyx
should not be given to patients with active tuberculosis. Anti-tuberculosis therapy should be
considered prior to initiation of Cosentyx in patients with latent tuberculosis.
Crohn’s disease
Caution should be exercised when prescribing Cosentyx to patients with Crohn’s disease as
exacerbations of Crohn’s disease, in some cases serious, were observed in clinical studies in both
Cosentyx and placebo groups. Patients who are treated with Cosentyx and have Crohn’s disease
should be followed closely.
15
Hypersensitivity reactions
Latex-sensitive individuals
The removable needle cap of the Cosentyx pre-filled syringe contains a derivative of natural rubber
latex. No natural rubber latex has to date been detected in the removable needle cap. Nevertheless, the
use of Cosentyx pre-filled syringes in latex-sensitive individuals has not been studied and there is
therefore a potential risk of hypersensitivity reactions which cannot be completely ruled out.
Vaccinations
Patients receiving Cosentyx may receive concurrent inactivated or non-live vaccinations. In a study,
after meningococcal and inactivated influenza vaccinations, a similar proportion of healthy volunteers
treated with 150 mg of secukinumab and those treated with placebo were able to mount an adequate
immune response of at least a 4-fold increase in antibody titres to meningococcal and influenza
vaccines. The data suggest that Cosentyx does not suppress the humoral immune response to the
meningococcal or influenza vaccines.
In psoriasis studies, the safety and efficacy of Cosentyx in combination with immunosuppressants,
including biologics, or phototherapy have not been evaluated (see also section 4.5).
4.5 Interaction with other medicinal products and other forms of interaction
Live vaccines should not be given concurrently with Cosentyx (see also section 4.4).
No interaction studies have been performed in humans. There is no direct evidence for the role of
IL-17A in the expression of CYP450 enzymes. The formation of some CYP450 enzymes is
suppressed by increased levels of cytokines during chronic inflammation. Thus, anti-inflammatory
treatments, such as with the IL-17A inhibitor secukinumab, may result in normalisation of CYP450
levels with accompanying lower exposure of CYP450-metabolised co-medications. Therefore, a
clinically relevant effect on CYP450 substrates with a narrow therapeutic index, where the dose is
individually adjusted (e.g. warfarin) cannot be excluded. On initiation of secukinumab therapy in
patients being treated with these types of medicinal products, therapeutic monitoring should be
considered.
16
4.6 Fertility, pregnancy and lactation
Women of childbearing potential should use an effective method of contraception during treatment
and for at least 20 weeks after treatment.
Pregnancy
There are no adequate data from the use of secukinumab in pregnant women. Animal studies do not
indicate direct or indirect harmful effects with respect to pregnancy, embryonic/foetal development,
parturition or postnatal development (see section 5.3). As a precautionary measure, it is preferable to
avoid the use of Cosentyx in pregnancy.
Breast-feeding
It is not known whether secukinumab is excreted in human milk. Immunoglobulins are excreted in
human milk and it is not known if secukinumab is absorbed systemically after ingestion. Because of
the potential for adverse reactions in nursing infants from secukinumab, a decision on whether to
discontinue breast-feeding during treatment and up to 20 weeks after treatment or to discontinue
therapy with Cosentyx must be made taking into account the benefit of breast-feeding to the child and
the benefit of Cosentyx therapy to the woman.
Fertility
The effect of secukinumab on human fertility has not been evaluated. Animal studies do not indicate
direct or indirect harmful effects with respect to fertility (see section 5.3).
Cosentyx has no or negligible influence on the ability to drive and use machines.
A total of 4,498 patients have been treated with Cosentyx in blinded and open-label clinical studies in
various indications (plaque psoriasis and other autoimmune conditions). Of these, 1,900 patients were
exposed to Cosentyx for at least one year, representing 3,588 patient years of exposure.
Four placebo-controlled phase III studies in plaque psoriasis were pooled to evaluate the safety of
Cosentyx in comparison to placebo up to 12 weeks after treatment initiation. In total, 2,076 patients
were evaluated (692 patients on 150 mg, 690 patients on 300 mg and 694 patients on placebo).
The most frequently reported adverse drug reactions (ADRs) were upper respiratory tract infections
(most frequently nasopharyngitis, rhinitis). Most of the reactions were mild or moderate in severity.
17
Tabulated list of adverse reactions
ADRs from clinical studies (Table 1) are listed by MedDRA system organ class. Within each system
organ class, the ADRs are ranked by frequency, with the most frequent reactions first. Within each
frequency grouping, adverse drug reactions are presented in order of decreasing seriousness. In
addition, the corresponding frequency category for each adverse drug reaction is based on the
following convention: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to
<1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000).
Infections
In the placebo-controlled period of clinical studies in plaque psoriasis (a total of 1,382 patients treated
with Cosentyx and 694 patients treated with placebo for up to 12 weeks), infections were reported in
28.7% of patients treated with Cosentyx compared with 18.9% of patients treated with placebo. The
majority of infections consisted of non-serious and mild to moderate upper respiratory tract infections,
such as nasopharyngitis, which did not necessitate treatment discontinuation. There was an increase in
mucosal or cutaneous candidiasis, consistent with the mechanism of action, but the cases were mild or
moderate in severity, non-serious, responsive to standard treatment and did not necessitate treatment
discontinuation. Serious infections occurred in 0.14% of patients treated with Cosentyx and in 0.3% of
patients treated with placebo (see section 4.4).
Over the entire treatment period (a total of 3,430 patients treated with Cosentyx for up to 52 weeks for
the majority of patients), infections were reported in 47.5% of patients treated with Cosentyx (0.9 per
patient-year of follow-up). Serious infections were reported in 1.2% of patients treated with Cosentyx
(0.015 per patient-year of follow-up).
18
Neutropenia
Neutropenia was more frequently observed with secukinumab than with placebo, but most cases were
mild, transient and reversible. Neutropenia <1.0-0.5x109/l (CTCAE Grade 3) was reported in 18 out of
3,430 (0.5%) patients on secukinumab, with no dose dependence and no temporal relationship to
infections in 15 out of 18 cases. There were no reported cases of more severe neutropenia. Non-serious
infections with usual response to standard care and not requiring discontinuation of Cosentyx were
reported in the remaining 3 cases.
Hypersensitivity reactions
In clinical studies, urticaria and one case of anaphylactic reaction to Cosentyx were observed (see also
section 4.4).
Immunogenicity
Less than 1% of patients treated with Cosentyx developed antibodies to secukinumab up to 52 weeks
of treatment. About half of the treatment-emergent anti-drug antibodies were neutralising, but this was
not associated with loss of efficacy or pharmacokinetic abnormalities.
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare
professionals are asked to report any suspected adverse reactions via the national reporting system
listed in Appendix V.
4.9 Overdose
Doses up to 30 mg/kg (approximately 2000 to 3000 mg) have been administered intravenously in
clinical studies without dose-limiting toxicity. In the event of overdose, it is recommended that the
patient be monitored for any signs or symptoms of adverse reactions and appropriate symptomatic
treatment be instituted immediately.
5. PHARMACOLOGICAL PROPERTIES
Mechanism of action
Secukinumab is a fully human IgG1/κ monoclonal antibody that selectively binds to and neutralises
the proinflammatory cytokine interleukin-17A (IL-17A). Secukinumab works by targeting IL-17A and
inhibiting its interaction with the IL-17 receptor, which is expressed on various cell types including
keratinocytes. As a result, secukinumab inhibits the release of proinflammatory cytokines, chemokines
and mediators of tissue damage and reduces IL-17A-mediated contributions to autoimmune and
inflammatory diseases. Clinically relevant levels of secukinumab reach the skin and reduce local
inflammatory markers. As a direct consequence treatment with secukinumab reduces erythema,
induration and desquamation present in plaque psoriasis lesions.
IL-17A is a naturally occurring cytokine that is involved in normal inflammatory and immune
responses. IL-17A plays a key role in the pathogenesis of plaque psoriasis and is up-regulated in
lesional skin in contrast to non-lesional skin of plaque psoriasis patients.
19
Pharmacodynamic effects
Serum levels of total IL-17A (free and secukinumab-bound IL-17A) are initially increased in patients
receiving secukinumab. This is followed by a slow decrease due to reduced clearance of
secukinumab-bound IL-17A, indicating that secukinumab selectively captures free IL-17A, which
plays a key role in the pathogenesis of plaque psoriasis.
The safety and efficacy of Cosentyx were assessed in four randomised, double-blind,
placebo-controlled phase III studies in patients with moderate to severe plaque psoriasis who were
candidates for phototherapy or systemic therapy [ERASURE, FIXTURE, FEATURE, JUNCTURE].
The efficacy and safety of Cosentyx 150 mg and 300 mg were evaluated versus either placebo or
etanercept. In addition, one study assessed a chronic treatment regimen versus a “retreatment as
needed” regimen [SCULPTURE].
Of the 2,403 patients who were included in the placebo-controlled studies, 79% were biologic-naive,
45% were non-biologic failures and 8% were biologic failures (6% were anti-TNF failures, and 2%
were anti-p40 failures). Approximately 15 to 25% of patients in phase III studies had psoriatic arthritis
(PsA) at baseline.
Psoriasis Study 1 (ERASURE) evaluated 738 patients. Patients randomised to Cosentyx received
150 mg or 300 mg doses at Weeks 0, 1, 2, and 3, followed by the same dose every month starting at
Week 4. Psoriasis Study 2 (FIXTURE) evaluated 1,306 patients. Patients randomised to Cosentyx
received 150 mg or 300 mg doses at Weeks 0, 1, 2, and 3, followed by the same dose every month
starting at Week 4. Patients randomised to etanercept received 50 mg doses twice per week for
12 weeks followed by 50 mg every week. In both Study 1 and Study 2, patients randomised to receive
placebo who were non-responders at Week 12 then crossed over to receive Cosentyx (either 150 mg or
300 mg) at Weeks 12, 13, 14, and 15, followed by the same dose every month starting at Week 16. All
patients were followed for up to 52 weeks following first administration of study treatment.
Psoriasis Study 3 (FEATURE) evaluated 177 patients using a pre-filled syringe compared with
placebo after 12 weeks of treatment to assess the safety, tolerability, and usability of Cosentyx
self-administration via the pre-filled syringe. Psoriasis Study 4 (JUNCTURE) evaluated 182 patients
using a pre-filled pen compared with placebo after 12 weeks of treatment to assess the safety,
tolerability, and usability of Cosentyx self-administration via the pre-filled pen. In both Study 3 and
Study 4, patients randomised to Cosentyx received 150 mg or 300 mg doses at Weeks 0, 1, 2, and 3,
followed by the same dose every month starting at Week 4. Patients were also randomised to receive
placebo at Weeks 0, 1, 2, and 3, followed by the same dose every month starting at Week 4.
Psoriasis Study 5 (SCULPTURE) evaluated 966 patients. All patients received Cosentyx 150 mg or
300 mg doses at Weeks 0, 1, 2, 3, 4, 8 and 12 and then were randomised to receive either a
maintenance regimen of the same dose every month starting at Week 12 or a “retreatment as needed”
regimen of the same dose. Patients randomised to “retreatment as needed” did not achieve adequate
maintenance of response and therefore a fixed monthly maintenance regimen is recommended.
20
The co-primary endpoints in the placebo and active-controlled studies were the proportion of patients
who achieved a PASI 75 response and IGA mod 2011 “clear” or “almost clear” response versus
placebo at Week 12 (see Tables 2 and 3). The 300 mg dose provided improved skin clearance
particularly for “clear” or “almost clear” skin across the efficacy endpoints of PASI 90, PASI 100, and
IGA mod 2011 0 or 1 response across all studies with peak effects seen at Week 16, therefore this dose
is recommended.
Table 2 Summary of PASI 50/75/90/100 & IGA⃰ mod 2011 “clear” or “almost clear” clinical
response in Psoriasis Studies 1, 3 and 4 (ERASURE, FEATURE and JUNCTURE)
21
Table 3 Summary of clinical response on Psoriasis Study 2 (FIXTURE)
Cosentyx was associated with a fast onset of efficacy with a 50% reduction in mean PASI by Week 3
for the 300 mg dose.
Figure 1 Time course of percentage change from baseline of mean PASI score in Study 1
(ERASURE)
Weeks of treatment
n = number of patients evaluable
22
Quality of life/patient-reported outcomes
Statistically significant improvements at Week 12 (Studies 1-4) from baseline compared to placebo
were demonstrated in the DLQI (Dermatology Life Quality Index). Mean decreases (improvements) in
DLQI from baseline ranged from -10.4 to -11.6 with secukinumab 300 mg, from -7.7 to -10.1 with
secukinumab 150 mg, versus -1.1 to -1.9 for placebo at Week 12. These improvements were
maintained for 52 weeks (Studies 1 and 2).
Forty percent of the participants in Studies 1 and 2 completed the Psoriasis Symptom Diary©. For the
participants completing the diary in each of these studies, statistically significant improvements at
Week 12 from baseline compared to placebo in patient-reported signs and symptoms of itching, pain
and scaling were demonstrated.
Paediatric population
The European Medicines Agency has waived the obligation to submit the results of studies with
Cosentyx in plaque psoriasis in paediatric patients aged from birth to less than 6 years (see section 4.2
for information on paediatric use).
The European Medicines Agency has deferred the obligation to submit the results of studies with
Cosentyx in plaque psoriasis in paediatric patients aged from 6 years to less than 18 years (see
section 4.2 for information on paediatric use).
Absorption
Based on population pharmacokinetic analysis, following a single subcutaneous dose of either 150 mg
or 300 mg in plaque psoriasis patients, secukinumab reached peak serum concentrations of
13.7±4.8 µg/ml or 27.3±9.5 µg/ml, respectively, between 5 and 6 days post dose.
After initial weekly dosing during the first month, time to reach the maximum concentration was
between 31 and 34 days based on population pharmacokinetic analysis.
On the basis of simulated data, peak concentrations at steady-state (Cmax,ss) following subcutaneous
administration of 150 mg or 300 mg were 27.6 µg/ml and 55.2 µg/ml, respectively. Population
pharmacokinetic analysis suggests that steady-state is reached after 20 weeks with monthly dosing
regimens.
Compared with exposure after a single dose, the population pharmacokinetic analysis showed that
patients exhibited a 2-fold increase in peak serum concentrations and area under the curve (AUC)
following repeated monthly dosing during maintenance.
Population pharmacokinetic analysis showed that secukinumab was absorbed with an average absolute
bioavailability of 73% in patients with plaque psoriasis. Across studies, absolute bioavailabilities in
the range between 60 and 77% were calculated.
23
Distribution
The mean volume of distribution during the terminal phase (Vz) following single intravenous
administration ranged from 7.10 to 8.60 litres in plaque psoriasis patients, suggesting that
secukinumab undergoes limited distribution to peripheral compartments.
Biotransformation
The majority of IgG elimination occurs via intracellular catabolism, following fluid-phase or receptor
mediated endocytosis.
Elimination
Mean systemic clearance (CL) following a single intravenous administration to patients with plaque
psoriasis ranged from 0.13 to 0.36 l/day. In a population pharmacokinetic analysis, the mean systemic
clearance (CL) was 0.19 l/day in plaque psoriasis patients. The CL was not impacted by gender.
Clearance was dose- and time-independent.
The mean elimination half-life, as estimated from population pharmacokinetic analysis, was 27 days in
plaque psoriasis patients, ranging from 18 to 46 days across psoriasis studies with intravenous
administration.
Linearity/non-linearity
The single and multiple dose pharmacokinetics of secukinumab in plaque psoriasis patients were
determined in several studies with intravenous doses ranging from 1x 0.3 mg/kg to 3x 10 mg/kg and
with subcutaneous doses ranging from 1x 25 mg to multiple doses of 300 mg. Exposure was dose
proportional across all dosing regimens.
Elderly patients
Of the 3,430 plaque psoriasis patients exposed to Cosentyx in clinical studies, a total of 230 were
65 years of age or older and 32 patients were 75 years of age or older.
Based on population pharmacokinetic analysis with a limited number of elderly patients (n=71 for age
≥65 years and n=7 for age ≥75 years), clearance in elderly patients and patients less than 65 years of
age was similar.
No pharmacokinetic data are available in patients with renal or hepatic impairment. The renal
elimination of intact Cosentyx, an IgG monoclonal antibody, is expected to be low and of minor
importance. IgGs are mainly eliminated via catabolism and hepatic impairment is not expected to
influence clearance of Cosentyx.
Non-clinical data revealed no special risks for humans based on tissue cross-reactivity testing, safety
pharmacology, repeated dose and reproductive toxicity studies performed with secukinumab or a
murine anti-murine IL-17A antibody.
Since secukinumab binds to cynomolgus monkey and human IL-17A, its safety was studied in the
cynomolgus monkey. No undesirable effects of secukinumab were seen following subcutaneous
administration to cynomolgus monkeys for up to 13 weeks and intravenous administration up to
26 weeks (including pharmacokinetic, pharmacodynamic, immunogenicity and immunotoxicity (e.g.
T-cell dependent antibody response and NK cell activity) evaluations). The average serum
concentrations observed in monkeys after 13 weekly subcutaneous doses of 150 mg/kg were
24
considerably higher than the predicted average serum concentration expected in psoriatic patients at
the highest clinical dose. Antibodies to secukinumab were detected in only one of the exposed
animals. No non-specific tissue cross-reactivity was observed when secukinumab was applied to
normal human tissue.
Animal studies have not been conducted to evaluate the carcinogenic potential of secukinumab.
No undesirable effects of a murine anti-murine IL-17A antibody were seen in fertility and early
embryonic development and pre-and postnatal development studies in mice. The high dose used in
these studies was in excess of the maximum effective dose in terms of IL-17A suppression and activity
(see section 4.6).
6. PHARMACEUTICAL PARTICULARS
Trehalose dihydrate
L-histidine
L-histidine hydrochloride monohydrate
L-methionine
Polysorbate 80
Water for injections
6.2 Incompatibilities
In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal
products.
18 months
Cosentyx is supplied in a pre-filled 1 ml glass syringe with a FluroTec-coated plunger stopper, staked
27G x ½″ needle and rigid needle shield of styrene butadiene rubber assembled in a passive safety
device of polycarbonate.
25
6.6 Special precautions for disposal and other handling
Cosentyx 150 mg solution for injection is supplied in a single-use pre-filled syringe for individual use.
Do not shake or freeze the syringe. The syringe should be taken out of the refrigerator 20 minutes
before injecting to allow it to reach room temperature.
Prior to use, a visual inspection of the pre-filled syringe is recommended. The liquid should be clear.
Its colour may vary from colourless to slightly yellow. You may see a small air bubble, which is
normal. Do not use if the liquid contains easily visible particles, is cloudy or is distinctly brown.
Detailed instructions for use are provided in the package leaflet.
Any unused medicinal product or waste material should be disposed of in accordance with local
requirements.
EU/1/14/980/002
EU/1/14/980/003
Detailed information on this medicinal product is available on the website of the European Medicines
Agency http://www.ema.europa.eu.
26
This medicinal product is subject to additional monitoring. This will allow quick identification of
new safety information. Healthcare professionals are asked to report any suspected adverse reactions.
See section 4.8 for how to report adverse reactions.
3. PHARMACEUTICAL FORM
4. CLINICAL PARTICULARS
Cosentyx is indicated for the treatment of moderate to severe plaque psoriasis in adults who are
candidates for systemic therapy.
Cosentyx is intended for use under the guidance and supervision of a physician experienced in the
diagnosis and treatment of psoriasis.
Posology
The recommended dose is 300 mg of secukinumab by subcutaneous injection with initial dosing at
Weeks 0, 1, 2 and 3, followed by monthly maintenance dosing starting at Week 4. Each 300 mg dose
is given as two subcutaneous injections of 150 mg.
Consideration should be given to discontinuing treatment in patients who have shown no response up
to 16 weeks of treatment. Some patients with initially partial response may subsequently improve with
continued treatment beyond 16 weeks.
27
Paediatric population
The safety and efficacy of Cosentyx in children below the age of 18 years have not yet been
established. No data are available.
Method of administration
Cosentyx is to be administered by subcutaneous injection. If possible, areas of the skin that show
psoriasis should be avoided as injection sites.
After proper training in subcutaneous injection technique, patients may self-inject Cosentyx if a
physician determines that this is appropriate. However, the physician should ensure appropriate
follow-up of patients. Patients should be instructed to inject the full amount of Cosentyx according to
the instructions provided in the package leaflet. Comprehensive instructions for administration are
given in the package leaflet.
4.3 Contraindications
Severe hypersensitivity reactions to the active substance or to any of the excipients listed in
section 6.1.
Clinically important, active infection (e.g. active tuberculosis; see section 4.4).
Infections
Cosentyx has the potential to increase the risk of infections. In clinical studies, infections have been
observed in patients receiving Cosentyx (see section 4.8). Most of these were mild or moderate upper
respiratory tract infections such as nasopharyngitis and did not require treatment discontinuation.
Related to the mechanism of action of Cosentyx, non-serious mucocutaneous candida infections were
more frequently reported for secukinumab than placebo in the psoriasis clinical studies (3.55 per
100 patient years for secukinumab 300 mg versus 1.00 per 100 patient years for placebo) (see
section 4.8).
Caution should be exercised when considering the use of Cosentyx in patients with a chronic infection
or a history of recurrent infection.
Patients should be instructed to seek medical advice if signs or symptoms suggestive of an infection
occur. If a patient develops a serious infection, the patient should be closely monitored and Cosentyx
should not be administered until the infection resolves.
No increased susceptibility to tuberculosis was reported from clinical studies. However, Cosentyx
should not be given to patients with active tuberculosis. Anti-tuberculosis therapy should be
considered prior to initiation of Cosentyx in patients with latent tuberculosis.
Crohn’s disease
Caution should be exercised when prescribing Cosentyx to patients with Crohn’s disease as
exacerbations of Crohn’s disease, in some cases serious, were observed in clinical studies in both
Cosentyx and placebo groups. Patients who are treated with Cosentyx and have Crohn’s disease
should be followed closely.
28
Hypersensitivity reactions
Latex-sensitive individuals
The removable cap of the Cosentyx pre-filled pen contains a derivative of natural rubber latex. No
natural rubber latex has to date been detected in the removable cap. Nevertheless, the use of Cosentyx
pre-filled pens in latex-sensitive individuals has not been studied and there is therefore a potential risk
for hypersensitivity reactions which cannot be completely ruled out.
Vaccinations
Patients receiving Cosentyx may receive concurrent inactivated or non-live vaccinations. In a study,
after meningococcal and inactivated influenza vaccinations, a similar proportion of healthy volunteers
treated with 150 mg of secukinumab and those treated with placebo were able to mount an adequate
immune response of at least a 4-fold increase in antibody titres to meningococcal and influenza
vaccines. The data suggest that Cosentyx does not suppress the humoral immune response to the
meningococcal or influenza vaccines.
In psoriasis studies, the safety and efficacy of Cosentyx in combination with immunosuppressants,
including biologics, or phototherapy have not been evaluated (see also section 4.5).
4.5 Interaction with other medicinal products and other forms of interaction
Live vaccines should not be given concurrently with Cosentyx (see also section 4.4).
No interaction studies have been performed in humans. There is no direct evidence for the role of
IL-17A in the expression of CYP450 enzymes. The formation of some CYP450 enzymes is
suppressed by increased levels of cytokines during chronic inflammation. Thus, anti-inflammatory
treatments, such as with the IL-17A inhibitor secukinumab, may result in normalisation of CYP450
levels with accompanying lower exposure of CYP450-metabolised co-medications. Therefore, a
clinically relevant effect on CYP450 substrates with a narrow therapeutic index, where the dose is
individually adjusted (e.g. warfarin) cannot be excluded. On initiation of secukinumab therapy in
patients being treated with these types of medicinal products, therapeutic monitoring should be
considered.
29
4.6 Fertility, pregnancy and lactation
Women of childbearing potential should use an effective method of contraception during treatment
and for at least 20 weeks after treatment.
Pregnancy
There are no adequate data from the use of secukinumab in pregnant women. Animal studies do not
indicate direct or indirect harmful effects with respect to pregnancy, embryonic/foetal development,
parturition or postnatal development (see section 5.3). As a precautionary measure, it is preferable to
avoid the use of Cosentyx in pregnancy.
Breast-feeding
It is not known whether secukinumab is excreted in human milk. Immunoglobulins are excreted in
human milk and it is not known if secukinumab is absorbed systemically after ingestion. Because of
the potential for adverse reactions in nursing infants from secukinumab, a decision on whether to
discontinue breast-feeding during treatment and up to 20 weeks after treatment or to discontinue
therapy with Cosentyx must be made taking into account the benefit of breast-feeding to the child and
the benefit of Cosentyx therapy to the woman.
Fertility
The effect of secukinumab on human fertility has not been evaluated. Animal studies do not indicate
direct or indirect harmful effects with respect to fertility (see section 5.3).
Cosentyx has no or negligible influence on the ability to drive and use machines.
A total of 4,498 patients have been treated with Cosentyx in blinded and open-label clinical studies in
various indications (plaque psoriasis and other autoimmune conditions). Of these, 1,900 patients were
exposed to Cosentyx for at least one year, representing 3,588 patient years of exposure.
Four placebo-controlled phase III studies in plaque psoriasis were pooled to evaluate the safety of
Cosentyx in comparison to placebo up to 12 weeks after treatment initiation. In total, 2,076 patients
were evaluated (692 patients on 150 mg, 690 patients on 300 mg and 694 patients on placebo).
The most frequently reported adverse drug reactions (ADRs) were upper respiratory tract infections
(most frequently nasopharyngitis, rhinitis). Most of the reactions were mild or moderate in severity.
30
Tabulated list of adverse reactions
ADRs from clinical studies (Table 1) are listed by MedDRA system organ class. Within each system
organ class, the ADRs are ranked by frequency, with the most frequent reactions first. Within each
frequency grouping, adverse drug reactions are presented in order of decreasing seriousness. In
addition, the corresponding frequency category for each adverse drug reaction is based on the
following convention: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to
<1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000).
Infections
In the placebo-controlled period of clinical studies in plaque psoriasis (a total of 1,382 patients treated
with Cosentyx and 694 patients treated with placebo for up to 12 weeks), infections were reported in
28.7% of patients treated with Cosentyx compared with 18.9% of patients treated with placebo. The
majority of infections consisted of non-serious and mild to moderate upper respiratory tract infections,
such as nasopharyngitis, which did not necessitate treatment discontinuation. There was an increase in
mucosal or cutaneous candidiasis, consistent with the mechanism of action, but the cases were mild or
moderate in severity, non-serious, responsive to standard treatment and did not necessitate treatment
discontinuation. Serious infections occurred in 0.14% of patients treated with Cosentyx and in 0.3% of
patients treated with placebo (see section 4.4).
Over the entire treatment period (a total of 3,430 patients treated with Cosentyx for up to 52 weeks for
the majority of patients), infections were reported in 47.5% of patients treated with Cosentyx (0.9 per
patient-year of follow-up). Serious infections were reported in 1.2% of patients treated with Cosentyx
(0.015 per patient-year of follow-up).
31
Neutropenia
Neutropenia was more frequently observed with secukinumab than with placebo, but most cases were
mild, transient and reversible. Neutropenia <1.0-0.5x109/l (CTCAE Grade 3) was reported in 18 out of
3,430 (0.5%) patients on secukinumab, with no dose dependence and no temporal relationship to
infections in 15 out of 18 cases. There were no reported cases of more severe neutropenia. Non-serious
infections with usual response to standard care and not requiring discontinuation of Cosentyx were
reported in the remaining 3 cases.
Hypersensitivity reactions
In clinical studies, urticaria and one case of anaphylactic reaction to Cosentyx were observed (see also
section 4.4).
Immunogenicity
Less than 1% of patients treated with Cosentyx developed antibodies to secukinumab up to 52 weeks
of treatment. About half of the treatment-emergent anti-drug antibodies were neutralising, but this was
not associated with loss of efficacy or pharmacokinetic abnormalities.
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare
professionals are asked to report any suspected adverse reactions via the national reporting system
listed in Appendix V.
4.9 Overdose
Doses up to 30 mg/kg (approximately 2000 to 3000 mg) have been administered intravenously in
clinical studies without dose-limiting toxicity. In the event of overdose, it is recommended that the
patient be monitored for any signs or symptoms of adverse reactions and appropriate symptomatic
treatment be instituted immediately.
5. PHARMACOLOGICAL PROPERTIES
Mechanism of action
Secukinumab is a fully human IgG1/κ monoclonal antibody that selectively binds to and neutralises
the proinflammatory cytokine interleukin-17A (IL-17A). Secukinumab works by targeting IL-17A and
inhibiting its interaction with the IL-17 receptor, which is expressed on various cell types including
keratinocytes. As a result, secukinumab inhibits the release of proinflammatory cytokines, chemokines
and mediators of tissue damage and reduces IL-17A-mediated contributions to autoimmune and
inflammatory diseases. Clinically relevant levels of secukinumab reach the skin and reduce local
inflammatory markers. As a direct consequence treatment with secukinumab reduces erythema,
induration and desquamation present in plaque psoriasis lesions.
IL-17A is a naturally occurring cytokine that is involved in normal inflammatory and immune
responses. IL-17A plays a key role in the pathogenesis of plaque psoriasis and is up-regulated in
lesional skin in contrast to non-lesional skin of plaque psoriasis patients.
32
Pharmacodynamic effects
Serum levels of total IL-17A (free and secukinumab-bound IL-17A) are initially increased in patients
receiving secukinumab. This is followed by a slow decrease due to reduced clearance of
secukinumab-bound IL-17A, indicating that secukinumab selectively captures free IL-17A, which
plays a key role in the pathogenesis of plaque psoriasis.
The safety and efficacy of Cosentyx were assessed in four randomised, double-blind,
placebo-controlled phase III studies in patients with moderate to severe plaque psoriasis who were
candidates for phototherapy or systemic therapy [ERASURE, FIXTURE, FEATURE, JUNCTURE].
The efficacy and safety of Cosentyx 150 mg and 300 mg were evaluated versus either placebo or
etanercept. In addition, one study assessed a chronic treatment regimen versus a “retreatment as
needed” regimen [SCULPTURE].
Of the 2,403 patients who were included in the placebo-controlled studies, 79% were biologic-naive,
45% were non-biologic failures and 8% were biologic failures (6% were anti-TNF failures, and 2%
were anti-p40 failures). Approximately 15 to 25% of patients in phase III studies had psoriatic arthritis
(PsA) at baseline.
Psoriasis Study 1 (ERASURE) evaluated 738 patients. Patients randomised to Cosentyx received
150 mg or 300 mg doses at Weeks 0, 1, 2, and 3, followed by the same dose every month starting at
Week 4. Psoriasis Study 2 (FIXTURE) evaluated 1,306 patients. Patients randomised to Cosentyx
received 150 mg or 300 mg doses at Weeks 0, 1, 2, and 3, followed by the same dose every month
starting at Week 4. Patients randomised to etanercept received 50 mg doses twice per week for
12 weeks followed by 50 mg every week. In both Study 1 and Study 2, patients randomised to receive
placebo who were non-responders at Week 12 then crossed over to receive Cosentyx (either 150 mg or
300 mg) at Weeks 12, 13, 14, and 15, followed by the same dose every month starting at Week 16. All
patients were followed for up to 52 weeks following first administration of study treatment.
Psoriasis Study 3 (FEATURE) evaluated 177 patients using a pre-filled syringe compared with
placebo after 12 weeks of treatment to assess the safety, tolerability, and usability of Cosentyx
self-administration via the pre-filled syringe. Psoriasis Study 4 (JUNCTURE) evaluated 182 patients
using a pre-filled pen compared with placebo after 12 weeks of treatment to assess the safety,
tolerability, and usability of Cosentyx self-administration via the pre-filled pen. In both Study 3 and
Study 4, patients randomised to Cosentyx received 150 mg or 300 mg doses at Weeks 0, 1, 2, and 3,
followed by the same dose every month starting at Week 4. Patients were also randomised to receive
placebo at Weeks 0, 1, 2, and 3, followed by the same dose every month starting at Week 4.
Psoriasis Study 5 (SCULPTURE) evaluated 966 patients. All patients received Cosentyx 150 mg or
300 mg doses at Weeks 0, 1, 2, 3, 4, 8 and 12 and then were randomised to receive either a
maintenance regimen of the same dose every month starting at Week 12 or a “retreatment as needed”
regimen of the same dose. Patients randomised to “retreatment as needed” did not achieve adequate
maintenance of response and therefore a fixed monthly maintenance regimen is recommended.
33
The co-primary endpoints in the placebo and active-controlled studies were the proportion of patients
who achieved a PASI 75 response and IGA mod 2011 “clear” or “almost clear” response versus
placebo at Week 12 (see Tables 2 and 3). The 300 mg dose provided improved skin clearance
particularly for “clear” or “almost clear” skin across the efficacy endpoints of PASI 90, PASI 100, and
IGA mod 2011 0 or 1 response across all studies with peak effects seen at Week 16, therefore this dose
is recommended.
Table 2 Summary of PASI 50/75/90/100 & IGA⃰ mod 2011 “clear” or “almost clear” clinical
response in Psoriasis Studies 1, 3 and 4 (ERASURE, FEATURE and JUNCTURE)
34
Table 3 Summary of clinical response on Psoriasis Study 2 (FIXTURE)
Cosentyx was associated with a fast onset of efficacy with a 50% reduction in mean PASI by Week 3
for the 300 mg dose.
Figure 1 Time course of percentage change from baseline of mean PASI score in Study 1
(ERASURE)
Weeks of treatment
n = number of patients evaluable
35
Forty percent of the participants in Studies 1 and 2 completed the Psoriasis Symptom Diary©. For the
participants completing the diary in each of these studies, statistically significant improvements at
Week 12 from baseline compared to placebo in patient-reported signs and symptoms of itching, pain
and scaling were demonstrated.
Paediatric population
The European Medicines Agency has waived the obligation to submit the results of studies with
Cosentyx in plaque psoriasis in paediatric patients aged from birth to less than 6 years (see section 4.2
for information on paediatric use).
The European Medicines Agency has deferred the obligation to submit the results of studies with
Cosentyx in plaque psoriasis in paediatric patients aged from 6 years to less than 18 years (see
section 4.2 for information on paediatric use).
Absorption
Based on population pharmacokinetic analysis, following a single subcutaneous dose of either 150 mg
or 300 mg in plaque psoriasis patients, secukinumab reached peak serum concentrations of
13.7±4.8 µg/ml or 27.3±9.5 µg/ml, respectively, between 5 and 6 days post dose.
After initial weekly dosing during the first month, time to reach the maximum concentration was
between 31 and 34 days based on population pharmacokinetic analysis.
On the basis of simulated data, peak concentrations at steady-state (Cmax,ss) following subcutaneous
administration of 150 mg or 300 mg were 27.6 µg/ml and 55.2 µg/ml, respectively. Population
pharmacokinetic analysis suggests that steady-state is reached after 20 weeks with monthly dosing
regimens.
Compared with exposure after a single dose, the population pharmacokinetic analysis showed that
patients exhibited a 2-fold increase in peak serum concentrations and area under the curve (AUC)
following repeated monthly dosing during maintenance.
Population pharmacokinetic analysis showed that secukinumab was absorbed with an average absolute
bioavailability of 73% in patients with plaque psoriasis. Across studies, absolute bioavailabilities in
the range between 60 and 77% were calculated.
Distribution
The mean volume of distribution during the terminal phase (Vz) following single intravenous
administration ranged from 7.10 to 8.60 litres in plaque psoriasis patients, suggesting that
secukinumab undergoes limited distribution to peripheral compartments.
Biotransformation
The majority of IgG elimination occurs via intracellular catabolism, following fluid-phase or receptor
mediated endocytosis.
36
Elimination
Mean systemic clearance (CL) following a single intravenous administration to patients with plaque
psoriasis ranged from 0.13 to 0.36 l/day. In a population pharmacokinetic analysis, the mean systemic
clearance (CL) was 0.19 l/day in plaque psoriasis patients. The CL was not impacted by gender.
Clearance was dose- and time-independent.
The mean elimination half-life, as estimated from population pharmacokinetic analysis, was 27 days in
plaque psoriasis patients, ranging from 18 to 46 days across psoriasis studies with intravenous
administration.
Linearity/non-linearity
The single and multiple dose pharmacokinetics of secukinumab in plaque psoriasis patients were
determined in several studies with intravenous doses ranging from 1x 0.3 mg/kg to 3x 10 mg/kg and
with subcutaneous doses ranging from 1x 25 mg to multiple doses of 300 mg. Exposure was dose
proportional across all dosing regimens.
Elderly patients
Of the 3,430 plaque psoriasis patients exposed to Cosentyx in clinical studies, a total of 230 were
65 years of age or older and 32 patients were 75 years of age or older.
Based on population pharmacokinetic analysis with a limited number of elderly patients (n=71 for age
≥65 years and n=7 for age ≥75 years), clearance in elderly patients and patients less than 65 years of
age was similar.
No pharmacokinetic data are available in patients with renal or hepatic impairment. The renal
elimination of intact Cosentyx, an IgG monoclonal antibody, is expected to be low and of minor
importance. IgGs are mainly eliminated via catabolism and hepatic impairment is not expected to
influence clearance of Cosentyx.
Non-clinical data revealed no special risks for humans based on tissue cross-reactivity testing, safety
pharmacology, repeated dose and reproductive toxicity studies performed with secukinumab or a
murine anti-murine IL-17A antibody.
Since secukinumab binds to cynomolgus monkey and human IL-17A, its safety was studied in the
cynomolgus monkey. No undesirable effects of secukinumab were seen following subcutaneous
administration to cynomolgus monkeys for up to 13 weeks and intravenous administration up to
26 weeks (including pharmacokinetic, pharmacodynamic, immunogenicity and immunotoxicity (e.g.
T-cell dependent antibody response and NK cell activity) evaluations). The average serum
concentrations observed in monkeys after 13 weekly subcutaneous doses of 150 mg/kg were
considerably higher than the predicted average serum concentration expected in psoriatic patients at
the highest clinical dose. Antibodies to secukinumab were detected in only one of the exposed
animals. No non-specific tissue cross-reactivity was observed when secukinumab was applied to
normal human tissue.
Animal studies have not been conducted to evaluate the carcinogenic potential of secukinumab.
37
No undesirable effects of a murine anti-murine IL-17A antibody were seen in fertility and early
embryonic development and pre-and postnatal development studies in mice. The high dose used in
these studies was in excess of the maximum effective dose in terms of IL-17A suppression and activity
(see section 4.6).
6. PHARMACEUTICAL PARTICULARS
Trehalose dihydrate
L-histidine
L-histidine hydrochloride monohydrate
L-methionine
Polysorbate 80
Water for injections
6.2 Incompatibilities
In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal
products.
18 months
Cosentyx is supplied in a single-use pre-filled syringe assembled into a triangular-shaped pen with
transparent window and label (SensoReady pen). The pre-filled syringe inside the pen is a 1 ml glass
syringe with a FluroTec-coated plunger stopper, staked 27G x ½″ needle and rigid needle shield of
styrene butadiene rubber.
Cosentyx 150 mg solution for injection is supplied in a single-use pre-filled pen for individual use. Do
not shake or freeze the pen. The pen should be taken out of the refrigerator 20 minutes before injecting
to allow it to reach room temperature.
Prior to use, a visual inspection of the pre-filled pen is recommended. The liquid should be clear. Its
colour may vary from colourless to slightly yellow. You may see a small air bubble, which is normal.
Do not use if the liquid contains easily visible particles, is cloudy or is distinctly brown. Detailed
instructions for use are provided in the package leaflet.
Any unused medicinal product or waste material should be disposed of in accordance with local
requirements.
38
7. MARKETING AUTHORISATION HOLDER
EU/1/14/980/004
EU/1/14/980/005
Detailed information on this medicinal product is available on the website of the European Medicines
Agency http://www.ema.europa.eu.
39
ANNEX II
40
A. MANUFACTURER OF THE BIOLOGICAL ACTIVE SUBSTANCE AND
MANUFACTURER RESPONSIBLE FOR BATCH RELEASE
Medicinal product subject to restricted medical prescription (see Annex I: Summary of Product
Characteristics, section 4.2).
The marketing authorisation holder shall submit the first periodic safety update report for this product
within 6 months following authorisation. Subsequently, the marketing authorisation holder shall
submit periodic safety update reports for this product in accordance with the requirements set out in
the list of Union reference dates (EURD list) provided for under Article 107c(7) of Directive
2001/83/EC and published on the European medicines web-portal.
The MAH shall perform the required pharmacovigilance activities and interventions detailed in the
agreed RMP presented in Module 1.8.2 of the Marketing Authorisation and any agreed subsequent
updates of the RMP.
If the submission of a PSUR and the update of a RMP coincide, they can be submitted at the same
time.
41
ANNEX III
42
A. LABELLING
43
PARTICULARS TO APPEAR ON THE OUTER PACKAGING
CARTON – vial
One vial contains 150 mg secukinumab. After reconstitution, 1 ml of solution contains 150 mg
secukinumab.
3. LIST OF EXCIPIENTS
1 vial
Subcutaneous use
Read the package leaflet before use.
8. EXPIRY DATE
EXP
Store in a refrigerator.
44
10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS
OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF
APPROPRIATE
EU/1/14/980/001
Lot
Cosentyx 150 mg
45
MINIMUM PARTICULARS TO APPEAR ON SMALL IMMEDIATE PACKAGING UNITS
VIAL LABEL
2. METHOD OF ADMINISTRATION
3. EXPIRY DATE
EXP
4. BATCH NUMBER
Lot
6. OTHER
46
PARTICULARS TO APPEAR ON THE OUTER PACKAGING
3. LIST OF EXCIPIENTS
1 pre-filled syringe
2 pre-filled syringes
Subcutaneous use
Read the package leaflet before use.
Single use.
8. EXPIRY DATE
EXP
47
9. SPECIAL STORAGE CONDITIONS
Lot
Cosentyx 150 mg
48
MINIMUM PARTICULARS TO APPEAR ON BLISTERS OR STRIPS
3. EXPIRY DATE
EXP
4. BATCH NUMBER
Lot
5. OTHER
49
MINIMUM PARTICULARS TO APPEAR ON SMALL IMMEDIATE PACKAGING UNITS
SYRINGE LABEL
2. METHOD OF ADMINISTRATION
3. EXPIRY DATE
EXP
4. BATCH NUMBER
Lot
6. OTHER
50
PARTICULARS TO APPEAR ON THE OUTER PACKAGING
3. LIST OF EXCIPIENTS
Subcutaneous use
Read the package leaflet before use.
Single use.
8. EXPIRY DATE
EXP
51
9. SPECIAL STORAGE CONDITIONS
Lot
Cosentyx 150 mg
52
MINIMUM PARTICULARS TO APPEAR ON SMALL IMMEDIATE PACKAGING UNITS
PEN LABEL
2. METHOD OF ADMINISTRATION
3. EXPIRY DATE
EXP
4. BATCH NUMBER
Lot
6. OTHER
SensoReady pen
53
B. PACKAGE LEAFLET
54
Package leaflet: Information for the patient
Secukinumab
This medicine is subject to additional monitoring. This will allow quick identification of new
safety information. You can help by reporting any side effects you may get. See the end of section 4
for how to report side effects.
Read all of this leaflet carefully before you start using this medicine because it contains
important information for you.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor, pharmacist or nurse.
- This medicine has been prescribed for you only. Do not pass it on to others. It may harm them,
even if their signs of illness are the same as yours.
- If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible
side effects not listed in this leaflet. See section 4.
Cosentyx belongs to a group of medicines called interleukin (IL) inhibitors. This medicine works by
neutralising the activity of a protein called IL-17A, which is present at increased levels in diseases
such as psoriasis.
Cosentyx is used to treat a skin condition called “plaque psoriasis”, which causes inflammation
affecting the skin. Cosentyx reduces the inflammation and other symptoms of the disease. Cosentyx is
used in adults with moderate to severe plaque psoriasis.
Using Cosentyx will benefit you by leading to improvements of skin clearance and reducing your
symptoms such as scaling, itching and pain.
55
Warnings and precautions
Tell your doctor or pharmacist before using Cosentyx:
if you currently have an infection or if you have long-term or repeated infections.
if you have tuberculosis.
if you have Crohn’s disease.
if you have recently had a vaccination or if you are due to have a vaccination during treatment
with Cosentyx.
if you are receiving any other treatment for psoriasis, such as another immunosuppressant or
phototherapy with ultraviolet (UV) light.
Stop using Cosentyx and tell your doctor or seek medical help immediately if you notice any signs
indicating a possible serious infection or an allergic reaction. Such signs are listed under “Serious side
effects” in section 4.
Cosentyx is given via injection under your skin (known as a subcutaneous injection) by a healthcare
professional.
Make sure you discuss with your doctor when you will have your injections and your follow-up
appointments.
For detailed instructions on how to reconstitute and inject Cosentyx, see “Instructions for use of
Cosentyx powder for solution for injection” at the end of this leaflet.
56
How much Cosentyx is given and for how long
Your doctor will decide how much Cosentyx you need and for how long.
After the first dose you will receive further weekly injections at Weeks 1, 2 and 3. From Week 4, you
will receive monthly injections. At each timepoint you will receive a 300 mg dose given as two
injections of 150 mg.
Cosentyx is for long-term treatment. Your doctor will regularly monitor your condition to check that
the treatment is having the desired effect.
If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.
Like all medicines, this medicine can cause side effects, although not everybody gets them.
57
Some side effects are very common (may affect more than 1 in 10 people):
upper respiratory tract infections with symptoms such as sore throat and stuffy nose
(nasopharyngitis, rhinitis)
Do not use this medicine after the expiry date which is stated on the outer box or vial after “EXP”.
Before reconstitution: Store the vial in the refrigerator between 2°C and 8°C.
After reconstitution: The solution can be used immediately or can be stored at 2°C to 8°C for up to
24 hours. Do not freeze. The solution should be administered within one hour after removal from 2°C
to 8°C storage.
This medicine is for single use only. Ask your pharmacist how to dispose of medicines no longer
required.
58
Marketing Authorisation Holder
Novartis Europharm Limited
Frimley Business Park
Camberley GU16 7SR
United Kingdom
Manufacturer
Novartis Pharma GmbH
Roonstraße 25
D-90429 Nuremberg
Germany
For any information about this medicine, please contact the local representative of the Marketing
Authorisation Holder:
België/Belgique/Belgien Lietuva
Novartis Pharma N.V. Novartis Pharma Services Inc.
Tél/Tel: +32 2 246 16 11 Tel: +370 5 269 16 50
България Luxembourg/Luxemburg
Novartis Pharma Services Inc. Novartis Pharma N.V.
Тел: +359 2 489 98 28 Tél/Tel: +32 2 246 16 11
Danmark Malta
Novartis Healthcare A/S Novartis Pharma Services Inc.
Tlf: +45 39 16 84 00 Tel: +356 2122 2872
Deutschland Nederland
Novartis Pharma GmbH Novartis Pharma B.V.
Tel: +49 911 273 0 Tel: +31 26 37 82 111
Eesti Norge
Novartis Pharma Services Inc. Novartis Norge AS
Tel: +372 66 30 810 Tlf: +47 23 05 20 00
Ελλάδα Österreich
Novartis (Hellas) A.E.B.E. Novartis Pharma GmbH
Τηλ: +30 210 281 17 12 Tel: +43 1 86 6570
España Polska
Novartis Farmacéutica, S.A. Novartis Poland Sp. z o.o.
Tel: +34 93 306 42 00 Tel.: +48 22 375 4888
France Portugal
Novartis Pharma S.A.S. Novartis Farma - Produtos Farmacêuticos, S.A.
Tél: +33 1 55 47 66 00 Tel: +351 21 000 8600
59
Hrvatska România
Novartis Hrvatska d.o.o. Novartis Pharma Services Romania SRL
Tel. +385 1 6274 220 Tel: +40 21 31299 01
Ireland Slovenija
Novartis Ireland Limited Novartis Pharma Services Inc.
Tel: +353 1 260 12 55 Tel: +386 1 300 75 50
Italia Suomi/Finland
Novartis Farma S.p.A. Novartis Finland Oy
Tel: +39 02 96 54 1 Puh/Tel: +358 (0)10 6133 200
Κύπρος Sverige
Novartis Pharma Services Inc. Novartis Sverige AB
Τηλ: +357 22 690 690 Tel: +46 8 732 32 00
60
Instructions for use of Cosentyx powder for solution for injection
The single-use vial contains 150 mg secukinumab for reconstitution with sterile water for injections.
Do not use the vial after the expiry date shown on the outer box or vial. If it has expired, return the
entire pack to the pharmacy.
The preparation of the solution for subcutaneous injection must be done without interruption and
ensuring that aseptic technique is used. The preparation time from piercing the stopper until end of
reconstitution takes 20 minutes on average and should not exceed 90 minutes.
To prepare Cosentyx 150 mg powder for solution for injection, please adhere to the following
instructions:
Instructions for reconstitution of Cosentyx 150 mg powder for solution for injection:
1. Bring the vial of powder to room temperature and ensure that the sterile water for injections is at
room temperature.
2. Withdraw slightly more than 1.0 ml sterile water for injections into a 1 ml graduated disposable
syringe and adjust to 1.0 ml.
3. Remove the plastic cap from the vial.
4. Insert the syringe needle into the vial containing the powder through the centre of the rubber
stopper and reconstitute the powder by slowly injecting 1.0 ml of sterile water for injections into
the vial. The stream of sterile water for injections should be directed onto the powder.
5. Tilt the vial to an angle of approx. 45° and gently rotate between the fingertips for approx.
1 minute. Do not shake or invert the vial.
6. Keep the vial standing at room temperature for a minimum of 10 minutes to allow for
dissolution. Note that foaming of the solution may occur.
7. Tilt the vial to an angle of approx. 45° and gently rotate between the fingertips for approx.
1 minute. Do not shake or invert the vial.
61
8. Allow the vial to stand undisturbed at room temperature for approximately 5 minutes. The
resulting solution should be clear. Its colour may vary from colourless to slightly yellow. Do not
use if the lyophilised powder has not fully dissolved or if the liquid contains easily visible
particles, is cloudy or is distinctly brown.
9. Prepare the required number of vials (2 vials for the 300 mg dose).
After preparation, the solution for subcutaneous injection can be used immediately or can be stored at
2°C to 8°C for up to 24 hours. Do not freeze. After storage at 2°C to 8°C, the solution should be
allowed to come to room temperature for approximately 20 minutes before administration. The
solution should be administered within one hour after removal from the 2°C to 8°C storage.
2. Carefully withdraw slightly more than 1.0 ml of the solution for subcutaneous injection from the
vial into a 1 ml graduated disposable syringe using a suitable needle (e.g. 21G x 2″). This needle
will only be used for withdrawing Cosentyx into the disposable syringe. Prepare the required
number of syringes (2 syringes for the 300 mg dose).
3. With the needle pointing upward, gently tap the syringe to move any air bubbles to the top.
62
4. Replace the attached needle with a 27G x ½″ needle.
5. Expel the air bubbles and advance the plunger to the 1.0 ml mark.
6. Clean the injection site with an alcohol swab.
7. Inject the Cosentyx solution subcutaneously into the front of thighs, lower abdomen (but not the
area 5 centimetres around the navel) or outer upper arms. Choose a different site each time an
injection is administered. Do not inject into areas where the skin is tender, bruised, red, scaly or
hard. Avoid areas with scars or stretch marks.
8. Any remaining solution in the vial must not be used and should be discarded in accordance with
local requirements. Vials are for single use only. Dispose of the used syringe in a sharps
container (closable, puncture-resistant container). For the safety and health of you and others,
needles and used syringes must never be re-used.
63
Package leaflet: Information for the patient
Secukinumab
This medicine is subject to additional monitoring. This will allow quick identification of new
safety information. You can help by reporting any side effects you may get. See the end of section 4
for how to report side effects.
Read all of this leaflet carefully before you start using this medicine because it contains
important information for you.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor, pharmacist or nurse.
- This medicine has been prescribed for you only. Do not pass it on to others. It may harm them,
even if their signs of illness are the same as yours.
- If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible
side effects not listed in this leaflet. See section 4.
Cosentyx belongs to a group of medicines called interleukin (IL) inhibitors. This medicine works by
neutralising the activity of a protein called IL-17A, which is present at increased levels in diseases
such as psoriasis.
Cosentyx is used to treat a skin condition called “plaque psoriasis”, which causes inflammation
affecting the skin. Cosentyx reduces the inflammation and other symptoms of the disease. Cosentyx is
used in adults with moderate to severe plaque psoriasis.
Using Cosentyx will benefit you by leading to improvements of skin clearance and reducing your
symptoms such as scaling, itching and pain.
64
Warnings and precautions
Tell your doctor or pharmacist before using Cosentyx:
if you currently have an infection or if you have long-term or repeated infections.
if you have tuberculosis.
if you have ever had an allergic reaction to latex.
if you have Crohn’s disease.
if you have recently had a vaccination or if you are due to have a vaccination during treatment
with Cosentyx.
if you are receiving any other treatment for psoriasis, such as another immunosuppressant or
phototherapy with ultraviolet (UV) light.
Stop using Cosentyx and tell your doctor or seek medical help immediately if you notice any signs
indicating a possible serious infection or an allergic reaction. Such signs are listed under “Serious side
effects” in section 4.
Always use this medicine exactly as your doctor has told you. Check with your doctor, nurse or
pharmacist if you are not sure.
Cosentyx is given via injection under your skin (known as a subcutaneous injection). You and your
doctor should decide if you should inject Cosentyx yourself.
It is important not to try to inject yourself until you have been trained by your doctor, nurse or
pharmacist. A caregiver may also give you your Cosentyx injection after proper training.
For detailed instructions on how to inject Cosentyx, see “Instructions for use of Cosentyx pre-filled
syringe” at the end of this leaflet.
65
How much Cosentyx is given and for how long
Your doctor will decide how much Cosentyx you need and for how long.
After the first dose you will receive further weekly injections at Weeks 1, 2 and 3. From Week 4, you
will receive monthly injections. At each timepoint you will receive a 300 mg dose given as two
injections of 150 mg.
Cosentyx is for long-term treatment. Your doctor will regularly monitor your condition to check that
the treatment is having the desired effect.
If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Some side effects are very common (may affect more than 1 in 10 people):
upper respiratory tract infections with symptoms such as sore throat and stuffy nose
(nasopharyngitis, rhinitis)
66
Some side effects are common (may affect up to 1 in 10 people):
cold sores (oral herpes)
diarrhoea
itchy rash (urticaria)
runny nose (rhinorrhoea)
Store the syringe sealed in its box to protect from light. Store in the refrigerator between 2°C and 8°C.
Do not freeze. Do not shake.
This medicine is for single use only. Ask your pharmacist how to dispose of medicines no longer
required.
67
Manufacturer
Novartis Pharma GmbH
Roonstraße 25
D-90429 Nuremberg
Germany
For any information about this medicine, please contact the local representative of the Marketing
Authorisation Holder:
België/Belgique/Belgien Lietuva
Novartis Pharma N.V. Novartis Pharma Services Inc.
Tél/Tel: +32 2 246 16 11 Tel: +370 5 269 16 50
България Luxembourg/Luxemburg
Novartis Pharma Services Inc. Novartis Pharma N.V.
Тел: +359 2 489 98 28 Tél/Tel: +32 2 246 16 11
Danmark Malta
Novartis Healthcare A/S Novartis Pharma Services Inc.
Tlf: +45 39 16 84 00 Tel: +356 2122 2872
Deutschland Nederland
Novartis Pharma GmbH Novartis Pharma B.V.
Tel: +49 911 273 0 Tel: +31 26 37 82 111
Eesti Norge
Novartis Pharma Services Inc. Novartis Norge AS
Tel: +372 66 30 810 Tlf: +47 23 05 20 00
Ελλάδα Österreich
Novartis (Hellas) A.E.B.E. Novartis Pharma GmbH
Τηλ: +30 210 281 17 12 Tel: +43 1 86 6570
España Polska
Novartis Farmacéutica, S.A. Novartis Poland Sp. z o.o.
Tel: +34 93 306 42 00 Tel.: +48 22 375 4888
France Portugal
Novartis Pharma S.A.S. Novartis Farma - Produtos Farmacêuticos, S.A.
Tél: +33 1 55 47 66 00 Tel: +351 21 000 8600
Hrvatska România
Novartis Hrvatska d.o.o. Novartis Pharma Services Romania SRL
Tel. +385 1 6274 220 Tel: +40 21 31299 01
68
Ireland Slovenija
Novartis Ireland Limited Novartis Pharma Services Inc.
Tel: +353 1 260 12 55 Tel: +386 1 300 75 50
Italia Suomi/Finland
Novartis Farma S.p.A. Novartis Finland Oy
Tel: +39 02 96 54 1 Puh/Tel: +358 (0)10 6133 200
Κύπρος Sverige
Novartis Pharma Services Inc. Novartis Sverige AB
Τηλ: +357 22 690 690 Tel: +46 8 732 32 00
69
Instructions for use of Cosentyx pre-filled syringe
Read ALL the way through these instructions before injecting. It is important not to try to inject
yourself until you have been trained by your doctor, nurse or pharmacist. The box contains Cosentyx
pre-filled syringe(s) individually sealed in a plastic blister.
After the medicine has been injected the syringe guard will be activated to cover the needle. This is
intended to aid in the protection of healthcare professionals, patients who self-inject doctor-prescribed
medicines, and individuals who assist self-injecting patients from accidental needlestick injuries.
70
Storage of the Cosentyx pre-filled syringe
1. Store this medicine sealed in its outer box to protect it from light. Store in the refrigerator
between 2°C and 8°C. DO NOT FREEZE.
2. Remember to take the syringe out of the refrigerator and allow it to reach room temperature
before preparing it for injection (15-30 minutes).
3. Do not use the syringe after the expiry date which is stated on the outer box or syringe label
after “EXP”. If it has expired, return the entire pack to the pharmacy.
The injection site is the place on the body where you are
going to use the syringe.
The recommended site is the front of your thighs. You
may also use the lower abdomen, but not the area
5 centimetres around the navel (belly button).
Choose a different site each time you give yourself an
injection.
Do not inject into areas where the skin is tender,
bruised, red, scaly or hard. Avoid areas with scars or
stretch marks.
If a caregiver is giving you the injection, the outer upper
arms may also be used.
71
How to use the Cosentyx pre-filled syringe
72
Slowly release the plunger and allow the syringe
guard to automatically cover the exposed needle.
Disposal instructions
73
Package leaflet: Information for the patient
Secukinumab
This medicine is subject to additional monitoring. This will allow quick identification of new
safety information. You can help by reporting any side effects you may get. See the end of section 4
for how to report side effects.
Read all of this leaflet carefully before you start using this medicine because it contains
important information for you.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor, pharmacist or nurse.
- This medicine has been prescribed for you only. Do not pass it on to others. It may harm them,
even if their signs of illness are the same as yours.
- If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible
side effects not listed in this leaflet. See section 4.
Cosentyx belongs to a group of medicines called interleukin (IL) inhibitors. This medicine works by
neutralising the activity of a protein called IL-17A, which is present at increased levels in diseases
such as psoriasis.
Cosentyx is used to treat a skin condition called “plaque psoriasis”, which causes inflammation
affecting the skin. Cosentyx reduces the inflammation and other symptoms of the disease. Cosentyx is
used in adults with moderate to severe plaque psoriasis.
Using Cosentyx will benefit you by leading to improvements of skin clearance and reducing your
symptoms such as scaling, itching and pain.
74
Warnings and precautions
Tell your doctor or pharmacist before using Cosentyx:
if you currently have an infection or if you have long-term or repeated infections.
if you have tuberculosis.
if you have ever had an allergic reaction to latex.
if you have Crohn’s disease.
if you have recently had a vaccination or if you are due to have a vaccination during treatment
with Cosentyx.
if you are receiving any other treatment for psoriasis, such as another immunosuppressant or
phototherapy with ultraviolet (UV) light.
Stop using Cosentyx and tell your doctor or seek medical help immediately if you notice any signs
indicating a possible serious infection or an allergic reaction. Such signs are listed under “Serious side
effects” in section 4.
Always use this medicine exactly as your doctor has told you. Check with your doctor, nurse or
pharmacist if you are not sure.
Cosentyx is given via injection under your skin (known as a subcutaneous injection). You and your
doctor should decide if you should inject Cosentyx yourself.
It is important not to try to inject yourself until you have been trained by your doctor, nurse or
pharmacist. A caregiver may also give you your Cosentyx injection after proper training.
For detailed instructions on how to inject Cosentyx, see “Instructions for use of the Cosentyx
SensoReady pen” at the end of this leaflet.
75
How much Cosentyx is given and for how long
Your doctor will decide how much Cosentyx you need and for how long.
After the first dose you will receive further weekly injections at Weeks 1, 2 and 3. From Week 4, you
will receive monthly injections. At each timepoint you will receive a 300 mg dose given as two
injections of 150 mg.
Cosentyx is for long-term treatment. Your doctor will regularly monitor your condition to check that
the treatment is having the desired effect.
If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Some side effects are very common (may affect more than 1 in 10 people):
upper respiratory tract infections with symptoms such as sore throat and stuffy nose
(nasopharyngitis, rhinitis)
76
Some side effects are common (may affect up to 1 in 10 people):
cold sores (oral herpes)
diarrhoea
itchy rash (urticaria)
runny nose (rhinorrhoea)
Store the pen sealed in its box to protect from light. Store in the refrigerator between 2°C and 8°C. Do
not freeze. Do not shake.
This medicine is for single use only. Ask your pharmacist how to dispose of medicines no longer
required.
77
Manufacturer
Novartis Pharma GmbH
Roonstraße 25
D-90429 Nuremberg
Germany
For any information about this medicine, please contact the local representative of the Marketing
Authorisation Holder:
België/Belgique/Belgien Lietuva
Novartis Pharma N.V. Novartis Pharma Services Inc.
Tél/Tel: +32 2 246 16 11 Tel: +370 5 269 16 50
България Luxembourg/Luxemburg
Novartis Pharma Services Inc. Novartis Pharma N.V.
Тел: +359 2 489 98 28 Tél/Tel: +32 2 246 16 11
Danmark Malta
Novartis Healthcare A/S Novartis Pharma Services Inc.
Tlf: +45 39 16 84 00 Tel: +356 2122 2872
Deutschland Nederland
Novartis Pharma GmbH Novartis Pharma B.V.
Tel: +49 911 273 0 Tel: +31 26 37 82 111
Eesti Norge
Novartis Pharma Services Inc. Novartis Norge AS
Tel: +372 66 30 810 Tlf: +47 23 05 20 00
Ελλάδα Österreich
Novartis (Hellas) A.E.B.E. Novartis Pharma GmbH
Τηλ: +30 210 281 17 12 Tel: +43 1 86 6570
España Polska
Novartis Farmacéutica, S.A. Novartis Poland Sp. z o.o.
Tel: +34 93 306 42 00 Tel.: +48 22 375 4888
France Portugal
Novartis Pharma S.A.S. Novartis Farma - Produtos Farmacêuticos, S.A.
Tél: +33 1 55 47 66 00 Tel: +351 21 000 8600
Hrvatska România
Novartis Hrvatska d.o.o. Novartis Pharma Services Romania SRL
Tel. +385 1 6274 220 Tel: +40 21 31299 01
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Ireland Slovenija
Novartis Ireland Limited Novartis Pharma Services Inc.
Tel: +353 1 260 12 55 Tel: +386 1 300 75 50
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Novartis Farma S.p.A. Novartis Finland Oy
Tel: +39 02 96 54 1 Puh/Tel: +358 (0)10 6133 200
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Novartis Pharma Services Inc. Novartis Sverige AB
Τηλ: +357 22 690 690 Tel: +46 8 732 32 00
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Instructions for use of the Cosentyx SensoReady pen
Secukinumab
These instructions are to help you to inject correctly using the Cosentyx
SensoReady pen.
It is important not to try to inject yourself until you have been trained by
your doctor, nurse or pharmacist.
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Before your injection:
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Your injection:
Correct Incorrect
The 1st click indicates that the injection has started. Several seconds
later a 2nd click will indicate that the injection is almost finished.
You must keep holding the pen firmly against your skin until you see a
green indicator fill the window and stop moving.
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After your injection:
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