Introduction

Ixekizumab (trade name: Taltz) has been approved in Germany since October 2016 for the systemic treatment of moderate to severe plaque psoriasis in adults. Since January 2018, ixekizumab has also been approved for the treatment of psoriatic arthritis if previous treatment with conventional antirheumatic medication or biological drugs was not effective enough or is not an option.

Psoriasis is a non-contagious inflammatory skin disease. The symptoms usually include clearly defined red patches (called "plaques"), scaly skin and often itching too. They come and go in bouts: The skin can get better on its own, but it may also suddenly get worse. Psoriasis is a chronic (long-lasting) condition that currently has no cure.

The most common form, affecting about 85% of people with psoriasis, is called plaque psoriasis or psoriasis vulgaris. Psoriatic arthritis (arthritis psoriatica) is less common. It also involves swelling, inflammation and pain in your joints.

Plaque psoriasis is usually treated with medications applied directly to the skin (topically), for instance with creams or ointments. Phototherapy (light therapy) is an option for people with more severe psoriasis. There are also medications designed to slow down or stop the inflammatory process in different ways. They can either be taken as tablets or injected into the bloodstream. This form of treatment is called systemic treatment.

Patients are first given conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate or leflunomide. If these are no longer effective enough, medications produced using biotechnology (biological drugs, or biologics) can be used instead. These include the drugs etanercept, golimumab, adalimumab or infliximab.

Treatment with ixekizumab aims to decrease the inflammation by inhibiting a protein, thereby reducing the production of several chemical messengers that promote inflammation.

Application

Ixekizumab is available in ready-to-use injection pens at a dose of 80 mg.

In moderate or severe plaque psoriasis, a dose of 160 mg is injected under the skin once in the first week of treatment. During the following 12 weeks, 80 mg of ixekizumab are injected every two weeks. After that, one dose of 80 mg is used per month.

For the treatment of psoriatic arthritis, ixekizumab is initially injected once at a dose of 160 mg and then once a month at a dose of 80 mg.

If both conditions occur together, ixekizumab is used in the same way as it is for the treatment of plaque psoriasis.

Patients can also inject themselves after being instructed how to do so by a doctor. The success of the treatment needs to be assessed regularly. If there is no improvement after 16 to 20 weeks people are usually advised to stop the treatment.

Other treatments

For people with moderate to severe plaque psoriasis who are able to have systemic therapy, phototherapy is an option, as well as the drugs fumaric acid ester, ciclosporin, or methotrexate.

If these treatments were unsuccessful or are not suitable, the alternative options include treatment with biological drugs such as adalimubab or infliximab or with the drug ustekinumab.

For people with active psoriatic arthritis, the following treatments are options:

  • People whose condition is not expected to get worse quickly, and who have had previous treatment with a single conventional DMARD that wasn’t effective enough or could not be tolerated, can switch to either a different conventional DMARD such as methotrexate or leflunomide or to a combination of the two drugs.
  • For people who do not benefit enough from these conventional medications, a biological drug in combination with methotrexate is an option. If methotrexate isn’t well tolerated, the biological drug can be used on its own.
  • For people with psoriatic arthritis, switching to a different biological drug in combination with methotrexate is an option if a biologic drug used alone or in combination therapy wasn’t effective enough or wasn't well tolerated. In this case too, the biological drug can be used alone if methotrexate isn't well tolerated.

Assessment

The Institute for Quality and Efficiency in Health Care (IQWiG, Germany) last looked into whether ixekizumab offers any advantages or disadvantages when compared with the standard treatments in 2018.

The manufacturer provided suitable data for the following groups:

  • Adults with moderate to severe plaque psoriasis who didn't benefit enough from systemic treatment or were unable to have it.
  • Adults with moderate to severe plaque psoriasis who are able to have systemic treatment.
  • Adults with active psoriatic arthritis who no longer benefit enough from a previous treatment with conventional DMARDs and who are able to have treatment with biological drugs.

Learn more

More information

This information summarizes the main results of reviews produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The reviews were commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of these reviews and the hearings received, the G-BA passed a resolution on the added benefit of ixekizumab (Taltz) for the treatment of plaque psoriasis and active psoriatic arthritis.