In a trial only including 162 children and adolescents with severe psoriasis, secukinumab appeared to be slightly more effective than etanercept (a TNF-alpha antagonist) in the short term. However, in this trial, only half of the patients had already received a first-line systemic treatment considered to be insufficiently effective, and almost none had received a TNF-alpha antagonist. Secukinumab has not been compared to another immunosuppressant in children with moderate psoriasis. Given the shorter experience of use with secukinumab, the first choice should be a TNF-alpha antagonist.
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