Ixekizumab a viable long-term treatment option for axial spondyloarthritis

A 16-week treatment course of ixekizumab proves effective in the treatment of patients with active radiographic axial spondyloarthritis (r-axSpA) who are naïve to biological disease-modifying antirheumatic drug (bDMARD) or previously exposed to tumour necrosis factor inhibitor (TNFi), with the treatment benefits persisting for up to 52 weeks, according to the 2-year extension phase data from two phase III trials—COAST-V and COAST-W.

The analysis included 341 bDMARD-naïve patients treated with 80 mg ixekizumab every 2 (IXE Q2W) or 4 weeks (IXE Q4W), placebo or 40 mg adalimumab Q2W (ADA) in COAST-V, and 316 TNFi-experienced patients who received IXE Q2W, IXE Q4W or placebo in COAST-W.

At week 16, patients receiving ixekizumab continued their assigned treatment, whereas patients receiving placebo or ADA were randomly reassigned to receive IXE Q2W or IXE Q4W (placebo/IXE, ADA/IXE) through week 52.

In COAST-V, the respective Assessment of SpondyloArthritis international Society 40 (ASAS40) responses rates at weeks 16 and 52 were 48 percent and 53 percent in the IXE Q4W arm, 52 percent and 51 percent in the IXE Q2W arm, 36 percent and 51 percent in the ADA/IXE arm, and 19 percent and 47 percent in the placebo/IXE arm.

The corresponding 16- and 52-week ASAS40 response rates in COAST-W were 25 percent and 34 percent in the IXE Q4W arm, 31 percent and 31 percent in the IXE Q2W arm, and 14 percent and 39 percent in the placebo/IXE arm.

Ixekizumab-induced improvements in disease activity, physical function, objective markers of inflammation, QoL, health status and overall function were sustained for up to 52 weeks.

Safety findings were consistent with the known safety profile of ixekizumab.

The present data poise ixekizumab as a potential longer-term treatment option for patients with axSpA, regardless of prior experience with TNFi, the investigators said. “The additional numeric improvement in adalimumab-treated patients after switching to ixekizumab is of particular interest and deserves further exploration.”