Ixekizumab for the treatment of ankylosing spondylitis

ABSTRACT

Introduction

Ixekizumab (IXE) is a high affinity IgG4 approved for the treatment of ankylosing spondylitis (AS). Recently, two phase III randomized clinical trials (COAST-V, COAST-W) showed significant and sustained improvements in signs and symptoms of AS as evaluated by ASAS40 response. Areas covered: The authors performed a comprehensive literature search on this topic, by a review of published articles to date. The authors introduced the structure and the mechanism of action of IXE, and critically reviewed data from clinical trials, concerning its efficacy and safety in AS.Expert opinion: IXE proved dramatic efficacy and tolerable safety in patients with AS, in particular, patients with intolerance or insufficient response to TNFi, which provides an alternative and breakthrough for the treatment options of AS. IXE might not work in AS with IBD and uveitis involvement. Patients treated with IXE should be aware of candida infection in long term application.

KEYWORDS:

• Ixekizumab
• ankylosing spondylitis
• IL-17
• treatment
• secukinumab
• tumor necrosis factor inhibitors

Article highlights

• Ixekizumab (IXE) is a high affinity IgG4 approved for the treatment of ankylosing spondylitis (AS).

• IXE exerts its effect by targeting IL-17A and inhibiting the IL-17/IL-23 signaling pathway.

• Two phase III randomized clinical trials (COAST-V, COAST-W) proved efficacy and safety by a high standard treatment response of ASAS40 outcome measurement.

• IXE is strongly recommended in AS patients with TNFi failure or intolerance.

• IXE might be a safer choice for AS patients at higher risk for tuberculosis.

• IXE should be avoided in AS patients with symptoms of IBD and uveitis.

• IXE might increase the risk of candida infection due to the suppression of innate immune system.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.