anyone tried or recommended to use Secukinumab(cosentyx) for GCA?

[Elephants2019]

Prior to developing GCA, I had psoriasis(on scalp) controlled with topical steroid use. Once I began high steroid doses for GCA, the scalp psoriasis disappeared. I have been slowly tapering prednisone dose ( also on Actemra) and the psoriasis is returning, began itching around 10mg and now at 7.0-6.5. This afternoon I started a bit of reading regarding psoriasis and GCA and found some articles on Secukinumab as a possible GCA therapy. The one article stated that in trial MRA findings at 52 weeks 1/3 of patients on Actemra showed persistent or increased late vessel wall enhancement. These findings were a bit disturbing, as I developed a Thoracic Aortic Aneurysm from GCA. Thus thought would reach out for any insight from this knowledgeable group.

[PMRpro Ambassador]

I can't see how it would work for most patients with GCA since its mechanism of action isn't on a cytokine that has been greatly implicated in GCA even though it does seem to have some role.

Actemra works on IL-6 which is the primary mechanism of action in GCA - and appears to be the sole mechanism in about half of patients as they are able to get off pred altogether. The other half get to a much lower dose since it inhibits the bulk of the inflammation but, since biologics are so specific, the other mechanisms are unaffected. That will include the IL-17 part so sekinumab may have a partial effect but it is likely to be incomplete. And you can't take more than 1 biologic at a time as far as I know,

Is that what you meant?

[Elephants2019 in reply to PMRpro]

Thank you for your insight! Have read IL-6(Actemra) and IL-17(cosentyx)…since I am two years in with GCA , on Actemra, prednisone, and Methotrexate (recently stopped methotrexate)and psoriasis coming back with lower prednisone dose means I have inflammation still going on….when reading the two trials, the cosentyx allowed GCA remission too, with a few patients that also had psoriasis. As I am slowly tapering off prednisone, GCA seems to be rearing it’s head, so know probably need to increase prednisone, but got me to thinking🤔Would make things easier if we all knew what markers were causing inflammation and treat that cause. I was just curious if anyone else on this forum had GCA and psoriasis and if they had tried cosentyx vs Actemra. I read the Actemra had to be stopped prior to starting Cosentyx.

Thank you for your thoughts!🙏

[PMRpro Ambassador in reply to Elephants2019]

There is someone with GCA/LVV and a history of psoriasis. Just occurs to me - were you diagnosed by biopsy or just symptoms?

[Elephants2019]

Just symptoms

[PMRpro Ambassador in reply to Elephants2019]

So I wonder - IS it really GCA? Spondyloarthropathies can mimic GCA and PMR if they affect the neck, especially if it is ankyosing spondylitis. And psoriasis can be linked

[Elephants2019]

My symptoms point more to GCA, but who knows? The doctor did not think necessary to do the genectic test, for spondylitis which helps point to having that disease. I wish they did cytokine testing on us, to more effectively target treatment. I have asked for that too, but doctor did not think necessary.

[PMRpro Ambassador in reply to Elephants2019]

I have a friend who was first told PMR on symptoms - later GCA-like symptoms, even Prof Dasgupta thought it was GCA. It turned out to be ankylosing spondylitis.

[Elephants2019 in reply to PMRpro]

Thank you! Next appointment September 20, will certainly ask questions, and keep you posted, not sure if have incorrect diagnosis with GCA, but the psoriasis flaring has made me wonder.