Secukinumab (Cosentyx)

OFFICE / HOME HEALTH / SELF ADMINISTRATION

Indications for Prior Authorization:

  • Ankylosing Spondylitis
  • Psoriatic Arthritis
  • Plaque Psoriasis

Cosentyx is a preferred biologic agent for treatment of the following indications when all criteria below are met for specific indications:

  • Ankylosing spondylitis
  • Psoriatic Arthritis
  • Psoriasis

Patients must meet the following criteria for Ankylosing Spondylitis

  • Diagnosis of moderate to severe ankylosing spondylitis by rheumatologist (the prescribing MD does not have to be a rheumatologist), AND
  • Patient has tried and failed or had clinically significant adverse reactions to at least two NSAIDs for at least three months at maximal recommended doses, OR
  • Intolerable GI adverse events after a trial of prescription strength NSAID in combination with a PPI, OR
  • Unable to take NSAIDs due to history of GI bleed, AND
  • In patients without axial disease, inadequate response or intolerable side effect to one disease modifying anti-rheumatic drug (DMARD) or medical rational why sulfasalzine cannot be used, AND
  • Cosentyx will not be used concomitantly with other biologic DMARDs

For Psoriatic Arthritis

  • Diagnosis of active psoriatic arthritis made at baseline prior to initiation of DMARD therapy confirmed by rheumatologist or dermatologist, AND
  • Patient has failed to respond, or had clinically significant adverse effects to methotrexate unless contraindicated, AND
  • Inadequate response, intolerance, or contraindication to Enbrel or Humira
  • Cosentyx will not be used concomitantly with other biologic DMARDs

For Psoriasis

  • Diagnosis of plaque psoriatic confirmed by rheumatologist or dermatologist, AND
  • Baseline PASI score of 10 or more, AND
  • One of the following:
    • Inadequate response, intolerance or contraindication to PUVA or UVB treatment, OR,
    • Has difficulty accessing PUVA or UVB, AND
    • Inadequate resonse, intolerance, or contraindication to Enbrel or Humira. AND
  • One of the following:
    • Experienced inadequate response/intolerance to at least one of the following treatments: methotrexate, cyclosporine (Neoral), acitretin (Soriatane), OR
    • Contraindication to all the treatments listed. (A trial of these agents is not applicable for females actively attempting to conceive)
  • Cosentyx will not be used concomitantly with other biologic DMARDs

Dosing:

  • Recommended dose for Ankylosing Spondylitis:
    • With or without loading dosage:
      • With loading dose: 150 mg at weeks 0, 1, 2, 3, and 4 and every 4 weeks thereafter
      • Without loading dose: 150 mg every 4 weeks
  • Recommended dose for Psoriatic Arthritis:
    • For patients with coexistent moderate to severe plaque psoriasis, use the dosage and administration for plaque psoriasis
    • For other psoriatic arthritis patients administer with or without a loading dose.
      • With loading dose: 150 mg at weeks 0, 1, 2, 3, and 4 and every 4 weeks thereafter
      • Without loading dose: 150 mg every 4 weeks
      • If a patient continues to have active psoriatic arthritis, consider a dosage of 300 mg
  • Recommended dose for Plaque Psoriasis:
    • 300 mg at weeks 0, 1, 2, 3, and 4 followed by 300 mg every 4 weeks.  For some patients, a dose of 150 mg may be acceptable.

Approval Period:

  • One year to assess patient's response

Risk of Tuberculosis:

Patients should be evaluated for latent tuberculosis infection with a TB skin test.  Treatment of latent tuberculosis infection should be initiated prior to therapy with Cosentyx.

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