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Authoritative Clinical Reference
Schedule H
Subcutaneous injection
INDICATIONS + DOSING — FOR CLINICIAN USE ONLY
Primary Indications (Approved / Standard in India)
Adults (≥18 years):
Parameter Standard Dose (>90 kg or severe disease) Reduced Dose (≤90 kg or mild-moderate)
Starting dose 300 mg SC (as 2 Ă— 150 mg injections) at Week 0 150 mg SC at Week 0
Titration 300 mg SC weekly at Weeks 1, 2, 3, 4 150 mg SC weekly at Weeks 1, 2, 3, 4
Usual maintenance dose 300 mg SC every 4 weeks (from Week 8 onwards) 150 mg SC every 4 weeks
Maximum dose 300 mg every 4 weeks 300 mg every 4 weeks (if escalation needed)
Clinical notes: Response typically assessed at Week 12; consider alternative if no response by Week 16.
Adults — As monotherapy or with DMARDs (e.g., methotrexate):
Parameter Dose
Starting dose 150 mg SC at Week 0
Titration 150 mg SC weekly at Weeks 1, 2, 3, 4
Usual maintenance dose 150 mg SC every 4 weeks
Maximum dose 300 mg SC every 4 weeks
Dose escalation to 300 mg: Consider in anti-TNF insufficient responders or severe disease.
Adults:
Parameter Dose
Starting dose 150 mg SC at Week 0
Titration 150 mg SC weekly at Weeks 1, 2, 3, 4
Usual maintenance dose 150 mg SC every 4 weeks
Maximum dose 150 mg every 4 weeks
Adults with objective signs of inflammation (MRI evidence or elevated CRP):
Parameter Dose
Starting dose 150 mg SC at Week 0
Titration 150 mg SC weekly at Weeks 1, 2, 3, 4
Usual maintenance dose 150 mg SC every 4 weeks
Maximum dose 150 mg every 4 weeks
Secondary Indications — Adults (Off-label)
Indication Dose Duration Notes Evidence Basis
Hidradenitis Suppurativa 300 mg SC at Weeks 0, 1, 2, 3, 4, then 300 mg every 4 weeks Long-term maintenance OFF-LABEL; Specialist only International RCTs; under evaluation in India
Non-infectious Uveitis 300 mg SC loading, then 150–300 mg SC every 4 weeks Individualised OFF-LABEL; Not first-line; Specialist only Limited data from case series
PAEDIATRIC DOSING (Specialist Only)
Primary Indications (Approved / Standard in India)
Age ≥6 years — Weight-based dosing:
Weight Starting Dose Titration Maintenance Dose Maximum Dose
<50 kg 75 mg SC at Week 0 75 mg SC weekly at Weeks 1, 2, 3, 4 75 mg SC every 4 weeks 75 mg per dose
≥50 kg 150 mg SC at Week 0 150 mg SC weekly at Weeks 1, 2, 3, 4 150 mg SC every 4 weeks 150 mg per dose
Safety monitoring:
Secondary Indications — Paediatrics (Off-label)
Indication Dose Notes Evidence Basis
Juvenile Psoriatic Arthritis NOT APPROVED Not recommended in India Insufficient data
Ankylosing Spondylitis in adolescents Case-by-case dosing OFF-LABEL; Specialist only Limited Indian case-based experience
Age restriction: Not recommended below 6 years except under paediatric rheumatologist or dermatologist supervision.
| eGFR (ml/min/1.73m²) | Recommendation |
|---|
| Severity | Recommendation |
|---|---|
| Mild impairment | No formal data; use standard dose with close monitoring |
| Moderate impairment | No formal data; use with caution; monitor LFTs |
| Severe impairment | Insufficient data; use with extreme caution; specialist supervision recommended |
Parameter Recommendation
Risk category Limited human data; animal studies show no teratogenicity
When it may be used Only if no safer alternative for severe disease; after specialist input
Preferred alternatives Topical therapies; narrowband UVB where feasible
What to monitor Fetal growth, maternal infection risk, signs of immunosuppression in neonate if used in third trimester
Parameter Recommendation
Compatibility Compatible with breastfeeding
Drug levels in milk Likely low (monoclonal antibodies poorly secreted into breast milk)
Preferred alternatives Topical or non-biologic options if feasible
Infant monitoring Infections, feeding difficulties, growth parameters
Drug/Class Interaction Recommendation
Live vaccines (e.g., BCG, oral polio, MMR, varicella) Impaired vaccine efficacy; risk of disseminated infection Avoid during therapy and for at least 4 weeks after discontinuation
Other biologics (anti-TNF agents, other IL inhibitors) Additive immunosuppression; increased serious infection risk Avoid combination therapy
Potent immunosuppressants (azathioprine, cyclophosphamide) Additive immunosuppression Avoid or use with extreme caution
Drug/Class Interaction Recommendation
Methotrexate No pharmacokinetic interaction; may improve efficacy in PsA Allowed; monitor LFTs regularly
Corticosteroids (systemic) No direct interaction; additive immunosuppression possible Assess cumulative infection risk
CYP450-metabolised drugs (warfarin, cyclosporine) IL-17 inhibition may normalise CYP450 expression during inflammation resolution Monitor INR/drug levels when initiating or stopping secukinumab
Phase Parameters
Baseline TB screening (Mantoux test or IGRA); Hepatitis B and C serology; CBC with differential; LFTs; Chest X-ray if TB suspected
After initiation Clinical assessment for infections at each visit; GI symptoms (screen for IBD flare); injection site reactions
Long-term (every 3–6 months) CBC; LFTs (especially if on combination immunosuppressants); TB surveillance if ongoing risk; clinical efficacy assessment
| Formulation | Approximate Price (per tablet) |
|---|---|
| Scapho® 150 mg/mL prefilled syringe | ₹25,000–30,000 per syringe |
| Scapho® Sensoready® pen 150 mg/mL | ₹25,000–30,000 per pen |
Note: Not under NPPA price control; institutional access programs available in some states.
secukinumab; psoriasis; psoriatic arthritis; ankylosing spondylitis; IL-17 inhibitor; biologic therapy; TB-screening; immunomodulator; autoimmune diseases; NLEM-excluded
RxIndia v1.0 — 04 Apr 2025
This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.
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