NICE guidance - Ixekizumab for treating axial spondyloarthritis

Last edited 07/2021 and last reviewed 08/2021

Ixekizumab for treating axial spondyloarthritis

NICE guidance states:

• Ixekizumab is recommended as an option for treating active ankylosing spondylitis that is not controlled well enough with conventional therapy, or active non-radiographic axial spondyloarthritis with objective signs of inflammation (shown by elevated C-reactive protein or MRI) that is not controlled well enough with non-steroidal anti-inflammatory drugs (NSAIDs), in adults. It is recommended only if:
  • tumour necrosis factor (TNF)-alpha inhibitors are not suitable or do not control the condition well enough
• assess response to ixekizumab after 16 to 20 weeks of treatment. Continue treatment only if there is clear evidence of response, defined as:
  • a reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score to 50% of the pre-treatment value or by 2 or more units and
  • a reduction in the spinal pain visual analogue scale (VAS) by 2 cm or more

Notes:

• approximately 30-40% of patients with ankylosing spondylitis do not achieve adequate disease control or symptom relief according to clinical trials of TNF inhibitors (TNFi)
• interleukin-17 (IL-17) axis has been linked to the immunopathology of axial ankylosing spondylitis
  • Ixekizumab is a high-affinity monoclonal antibody that selectively targets IL-17A
  • study evidence demonstrate that the ixekizumab treatment regimens yield rapid and significant improvements in the signs and symptoms of radiographic axial ankylosing spondylitis, as well as a significant reduction in inflammation of the spine as measured by MRI, when compared to placebo
  • results support ixekizumab as a treatment option for patients with radiographic axial SpA and prior inadequate response to or intolerance of TNFi.

Reference:

• NICE (July 2021). Ixekizumab for treating axial spondyloarthritis
• Deodhar A et al; COAST-W Study Group. Efficacy and Safety of Ixekizumab in the Treatment of Radiographic Axial Spondyloarthritis: Sixteen-Week Results From a Phase III Randomized, Double-Blind, Placebo-Controlled Trial in Patients With Prior Inadequate Response to or Intolerance of Tumor Necrosis Factor Inhibitors. Arthritis Rheumatol. 2019 Apr;71(4):599-611