Ixekizumab

Ixekizumab is used to treat inflammatory types of arthritis, such as psoriatic arthritis (PsA) and ankylosing spondylitis (AS).

Ixekizumab is used when there has been an inadequate response to DMARD therapy. Ixekizumab is recommended to be used in combination with methotrexate (MTX) or other traditional DMARDs. For patients who cannot tolerate MTX, ixekizumab may be given as monotherapy.

Ixekizumab is never used in combination with other biologic medications. Combining ixekizumab with another biologic therapy is not recommended because of the increased risk of infection.

Ixekizumab is given by subcutaneous (s.c.) injection (meaning in the fatty layer of tissue just under the skin).  You, a family member or a friend can be taught how to give the injection.

The recommended dose is 160 mg s.c. (two 80 mg injections) at Week 0, followed by 80 mg every 4 weeks.

For psoriatic arthritis (PsA) patients with moderate-to-severe plaque psoriasis:

• 160 mg s.c. (two 80 mg injections) at Week 0, followed by 80 mg (one injection) at Weeks 2, 4, 6, 8, 10, and 12, then 80 mg (one injection) every 4 weeks.

For PsA patients with mild plaque psoriasis and ankylosing spondylitis (AS) patients:

• 160 mg at Week 0, followed by 80 mg every 4 weeks.

The medication comes in single-use pre-filled syringes or pre-filled auto injector for administration.

In some people with arthritis, a signalling protein called interleukin-17 (IL-17) is involved in the body’s inflammatory response where it attacks the body’s own tissues. Ixekizumab works by suppressing the body’s immune system, specifically it blocks IL-17 and prevents it from causing inflammation. By doing this, ixekizumab can help to reduce pain and swelling in the joints, improve day-to-day function, and prevent long term damage to the joints.

Like all of the biologics, you will not feel the effects of ixekizumab right away. Some people begin to feel the effects of ixekizumab within a few weeks; however, it may take three to six months to feel the full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for ixekizumab to take effect, your healthcare provider may recommend taking a steroid, such as prednisone or a non-steroidal anti-inflammatory drug (NSAID).

Ixekizumab can make it more difficult for your body to fight infections. People with active infections should not take ixekizumab. If you have a fever, think you have an infection or have been prescribed an antibiotic, contact your healthcare provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of ixekizumab with their prescriber.   

Also contact your healthcare provider if you are having surgery as you may need to stop ixekizumab until you are healed and there is no sign of infection.

Ixekizumab has not been studied in pregnant people or lactating parents so its effect(s) on pregnant people or nursing babies are unknown. You should tell your doctor if you are pregnant or are planning to become pregnant. Because of the potential for adverse reactions in nursing infants, a decision should be made on whether or not to discontinue nursing or the medication, taking into account the importance of the drug to the lactating parent.

Anyone who has had a previous allergic reaction to ixekizumab should avoid the medication.  

Before starting ixekizumab, tell your healthcare provider if you have inflammatory bowel disease (Crohn’s or ulcerative colitis). Ixekizumab can cause new onset or flares of inflammatory bowel disease.  Tell your healthcare provider if you develop diarrhea while taking ixekizumab.

Ideally, your vaccinations should be up to date prior to starting ixekizumab. If you have already started therapy with ixekizumab, your healthcare provider will likely recommend most inactive vaccines (e.g., influenza, pneumococcal). Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking ixekizumab, you should speak with your healthcare provider.

Like all medications, taking ixekizumab carries some risk of side effects, which must be balanced with the potential benefits. In general, the risk of joint damage and permanent disability (resulting from arthritis) is much greater than the risks of side effects from ixekizumab. When monitored properly the vast majority of side effects are rare, most improve over time and are reversible.

As with all DMARD and biologic medications, ixekizumab can lower the ability of your immune system to fight infections and increase your risk of infections. You should take precautions to minimize your risk of being infected by common contagious infections such as COVID-19, influenzae, pneumonia, and the common cold.

The most commonly reported side effect with ixekizumab is symptoms of a cold (sore throat, stuffy nose). Ixekizumab can cause a reaction (redness, pain, and itching) at the injection site. Other commonly reported symptoms include nausea and athlete’s foot. Talk to your healthcare provider if any of these symptoms affect you severely.

Before starting this medication, you will likely be tested for inactive (“latent”) tuberculosis (TB) and hepatitis B because ixekizumab can dampen the immune system and cause these infections to become active. If TB or hepatitis is found, it will need to be treated before you start ixekizumab. 

Rarely ixekizumab can cause a serious allergic reaction (feeling faint, swelling of the face, eyelids, tongue, lips, mouth or throat, trouble breathing, chest tightness).  If you have troublesome symptoms talk to your healthcare provider.

Take your ixekizumab as prescribed and contact your healthcare provider if you have any concerns while taking the medication.

To avoid injection reactions, injection sites should be rotated and avoid areas where the skin is tender, bruised, red and/or hard.

Blood tests are not routinely required while you are taking ixekizumab. Your healthcare provider may order periodic blood tests to check your blood count and follow the activity of your arthritis.

Ixekizumab must be protected from light until use. Store refrigerated at 2°C to 8°C (36°F to 46°F). Ixekizumab may be stored unrefrigerated for up to 5 days at a temperature not above 30ºC (86°F). Once it has reached room temperature, it cannot be returned to the fridge and must be disposed of by returning to the pharmacy if not used in 5 days.  Do not freeze. Do not use ixekizumab if it has been frozen. Do not shake.

The patient support program for Taltz is called “LillyPlus”. Their phone number is 1-877-219-8908.