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Interleukin 17 Inhibitor

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Interleukin 17 Inhibitor, IL-17 Monclonal Antibody, IL17 Inhibitor, Interleukin-17, IL-17, Brodalumab, Siliq, Ixekizumab, Taltz, Secukinumab, Cosentyx

  • See Also
  1. Interleukin 23 Inhibitor
  2. Interleukin
  3. Psoriasis
  • Indications
  1. Plaque Psoriasis (moderate to severe, candidates for systemic therapy or Phototherapy)
    1. Brodalumab (Siliq, adults)
    2. Ixekizumab (Taltz, includes children age >=6 years)
    3. Secukinumab (Cosentyx, child age >=6 years)
  2. Psoriatic Arthritis (active disease)
    1. Ixekizumab (Taltz, adults)
    2. Secukinumab (Cosentyx, child age >=2 years)
  3. Ankylosing Spondylitis. (active disease)
    1. Ixekizumab (Taltz, adults)
    2. Secukinumab (Cosentyx, adults)
  4. Non-radiographic axial spondyloarthritis with objective inflammation (active disease)
    1. Ixekizumab (Taltz)
    2. Secukinumab (Cosentyx, adults)
  5. Enthesitis-Related Arthritis (ERA, active)
    1. Secukinumab (Cosentyx, child age >=4 years)
  6. Hidradenitis Suppurativa (moderate to severe)
    1. Secukinumab (Cosentyx, adults)
  • Mechanism
  1. Interleukin 17 Alpha Inhibitor - (IL17-a Inhibitor)
    1. The Cytokines IL-23 and IL-17 are released from activated myeloid Dendritic Cells and Macrophages
    2. Cytokines (e.g. IL-17) trigger a proinflammatory cascade, activating immune cells (e.g. T cells)
      1. Angiogenesis
      2. Keratinocyte proliferation
      3. Immune cells migrate to within psoriatic lesions
  2. IL17 Monoclonal antibodies
    1. Self-injectable agents that target IL17
    2. Suppress IL17-triggered inflammatory response
  • Medications
  1. Brodalumab (Siliq)
    1. Plaque Psoriasis Adults: 210 mg SQ at week 0, week 1 and week 2, then every 2 weeks
  2. Ixekizumab (Taltz)
    1. Psoriatic Arthritis or Ankylosing Spondylitis (Adults) 160 mg SQ week 0, then 80 mg SQ every 4 weeks
    2. Plaque Psoriasis (Adults and child weight >50 kg)
      1. Start: 160 mg SQ at week 0
      2. Next: 80 mg SQ at weeks 2, 4, 6, 8, 10, 12
      3. Next: 80 mg SQ every 4 weeks
    3. Plaque Psoriasis (Child age >=6 years, weight <50 kg)
      1. Weight 25 to 50 kg: 80 mg at week 0, then 40 mg every 4 weeks
      2. Weight <25 kg: 40 mg at week 0, then 20 mg every 4 weeks
  3. Secukinumab (Cosentyx)
    1. Plaque Psoriasis
      1. Adults: 300 mg SQ at Weeks 0,1,2,3 and 4, and then every 4 weeks
      2. Child (age>=6 years)
        1. Weight <50 kg: 75 mg SQ at Weeks 0,1,2,3 and 4, and then every 4 weeks
        2. Weight >=50 kg: 150 mg SQ at Weeks 0,1,2,3 and 4, and then every 4 weeks
    2. Psoriatic Arthritis, Ankylosing Spondylitis, Non-Radiographic Axial Spondyloarthritis, Enthesitis-Related Arthritis
      1. Subcutaneous (SQ) in Adults for Psoriatic Arthritis, Ankylosing Spondylitis, Non-Radiographic Axial Spondyloarthritis
        1. Start: 150 mg SQ at Weeks 0, 1, 2, 3, and 4 and then every 4 weeks
        2. May increase to 300 mg SQ every 4 weeks for persistently active Psoriatic Arthritis
        3. For moderate to severe Psoriatic Arthritis, may load with the 300 mg dose (as with plaque Psoriasis)
        4. For mild cases, may start without load (150 mg SQ every 4 weeks)
      2. Intravenous (IV) in Adults with Psoriatic Arthritis, Ankylosing Spondylitis, Non-Radiographic Axial Spondyloarthritis
        1. Start 6 mg/kg IV load at Week 0, then maintenance 1.75 mg/kg (max 300 mg/infusion) IV every 4 weeks
        2. May also administer without loading dose, starting with 1.75 mg/kg maintenance dose
      3. Subcutaneous (SQ) in Children (age >=2 years) in Psoriatic Arthritis, Enthesitis-Related Arthritis
        1. Weight 15 to 50 kg: 75 mg SQ at Weeks 0,1,2,3 and 4, and then every 4 weeks
        2. Weight >=50 kg: 150 mg SQ at Weeks 0,1,2,3 and 4, and then every 4 weeks
    3. Hidradenitis Suppurativa (adults)
      1. Adults: 300 mg SQ at Weeks 0,1,2,3 and 4, and then every 4 weeks
      2. May increase to 300 mg SQ every 2 weeks if inadequate response to every 4 week maintenance dosing
  • Adverse Effects
  1. Serious
    1. Hypersensitivity Reaction (including Anaphylaxis)
    2. Suicidal Ideation (Brodalumab)
    3. Serious Infections
    4. Tuberculosis activation
      1. Test for Tuberculosis before initiating agents
    5. Inflammatory Bowel Disease (including Crohns Disease)
  2. Common
    1. Infections (URI, UTI, dermatophyte fungal infections, HSV)
    2. Headache
    3. Arthralgias
    4. Gastrointestinal (e.g. Nausea, Diarrhea)
    5. Eczematous Dermatitis flare
  • Safety
  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation
  • Drug Interactions
  1. Live Vaccines
    1. Avoid concurrently with IL-23 inhibitors
  • Resources
  1. Brodalumab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1a550c33-456a-4833-814e-8591aea7c688
  2. Ixekizumab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ac96658a-d7dc-4c7c-8928-2adcdf4318b2
  3. Secukinumab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=77c4b13e-7df3-42d4-81db-3d0cddb7f67a