Ixekizumab withdrawal may result in relapse in PsA

Among biologic‐naïve patients with psoriatic arthritis (PsA), continued ixekizumab therapy is more effective than discontinuation at sustaining low disease activity, according to data from a randomized, double‐blind withdrawal study.

The study included 394 adult PsA patients who were naïve to biologic therapy. They received open‐label ixekizumab (160 mg at week 0, 80 mg every two weeks [IXE Q2W]) for 36 weeks. Patients sustaining minimal disease activity (MDA) for >3 consecutive months were randomized (between weeks 36–64) to IXE Q2W withdrawal (placebo) or continued IXE Q2W treatment up to week 104.

Of the 158 (40 percent) patients who achieved sustained MDA on open-label ixekizumab, 79 were assigned to IXE Q2W withdrawal (placebo) and another 79 continued IXE Q2W treatment.

Relapse occurred more rapidly with treatment withdrawal than with continued IXE Q2W treatment (85 percent vs 38 percent; median not estimable; p<0.0001).

Sixty-four out of 67 patients (96 percent) who relapsed with treatment withdrawal re‐achieved MDA on retreatment. The median time to re‐achieving MDA was 4.1 weeks (95 percent confidence interval [CI] 4.1–4.3).

Safety was consistent with the known safety profile for ixekizumab.

The present data suggest that if MDA is to be maintained in PsA patients, continued ixekizumab treatment is necessary. However, in case of relapse following treatment interruption, disease control may be restored with ixekizumab retreatment.