What bDMARDs are available to inhibit IL 17 in the rheumatic diseases?
Secukinumab (Cosentyx) is a human IgG1κ monoclonal antibody which blocks IL-17A. It is FDA-approved to treat psoriasis, PsA, and AS. Not effective for RA.
- • Available formulations: 150 mg/mL solution in a single-use Sensoready pen or prefilled syringe that is self-administered. There is also a 150-mg lyophilized powder form for reconstitution and administration in office by a healthcare professional (Medicare part B insurance coverage eligible).
- • Adult PsA and AS dosage: 150 mg SC weekly × 4 (loading dose), then 150 mg SC every 4 weeks. Can be combined with a csDMARD (e.g., MTX).
- • Monitoring: routine monitoring for other csDMARDs (e.g., MTX).
- • Adverse reactions: injection site reactions, nasopharyngitis are most common. IL-17 is important for resistance to fungal infections. Opportunistic infections especially Candida have been reported. Development and/or exacerbation of Crohn’s disease have been reported.
- • Precautions: do not use in patients with active infection. Do not combine with other bDMARDs.
Ixekizumab (Taltz) is a humanized monoclonal antibody to IL-17A, which is FDA-approved to treat psoriasis and PsA.
- • Available formulations: 80-mg/mL solution in a single-dose prefilled autoinjector or syringe.
- • Adult PsA dosage: 160-mg SC loading dose, then 80-mg SC every 4 weeks. Can be combined with a csDMARD (e.g., MTX).
- • Adverse reactions, monitoring, and precautions similar to secukinumab.
