Ixekizumab for the treatment of psoriasis: up-to-date

ABSTRACT

Introduction: Ixekizumab (an IL-17A antagonist) is a biologic therapeutic licensed for use in moderate-to-severe plaque psoriasis and psoriatic arthritis. IL-17 antagonists (also including Secukinumab and Brodalumab) represent a new generation of biologic therapy with rapid and high response rates, quickly becoming a crucial part of the psoriasis treatment armamentarium.

Areas covered: In this review, we describe how IL-17A antagonists disrupt inflammatory cascades in psoriasis and summarize results from clinical trials examining the safety and efficacy of ixekizumab against placebo and comparators.

Expert opinion: Ixekizumab induces a 75% reduction in psoriasis area severity index (PASI 75) in 89% of patients after 12 weeks and after 1 year, PASI 75 is maintained in 80% of patients. Ixekizumab is superior to both etanercept and ustekinumab, however, further comparator trials are needed to determine superiority between newer agents. Network meta-analysis suggests that ixekizumab is one of the most rapid and efficacious agents for treating psoriasis, but ideally more long-term real-world data are needed to determine the persistence of response. Candida may be commonly encountered during treatment and IL-17 agents should be avoided in patients with inflammatory bowel disease. Overall, ixekizumab represents an efficacious and well-studied therapeutic that can offer biologic-naïve and bio-failure patients durable disease control.

KEYWORDS:

• Psoriasis
• plaque
• IL-17A
• cytokines
• biologic(s)
• inflammation

Article Highlights

• Critical evaluation of ixekizumab efficacy against other IL-17 antagonists and different families of biologics

• Ixekizumab efficacy in genital psoriasis, generalized pustular psoriasis, and psoriatic arthritis

• The clinical impact of common and serious adverse events

• Expert opinion of ixekizumab’s overall utility in clinical practice.

This box summarizes the key points contained in the article.

Declaration of interest

S Craig is employed by Manchester Cancer Research Centre and Leeds Teaching Hospitals NHS Foundation Trust. Her research has been funded previously by the National Institute of Health Research and The British Research Council. R Warren is employed by Salford Royal Hospital and Manchester University. Research Grants: AbbVie, Almirall, Amgen, Celgene, Janssen, Lilly, Leo, Novartis, Pfizer & UCB. Consulting Fees: AbbVie, Almirall, Amgen, Arena, Avillion, Bristol Myers Squibb, Boehringer Ingelheim, Celgene, Janssen, Leo, Lilly, Novartis, Pfizer, Sanofi & UCB. The authors have no other 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 apart from those disclosed.

Reviewer Disclosures

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

Additional information

Funding

This paper is not funded.