Ixekizumab

How it works

It selectively binds interleukin-17A, neutralising this pro-inflammatory cytokine and reducing the keratinocyte activation and inflammation that drive psoriatic plaques.

Prescribing in practice

• Screen for latent tuberculosis and active infection before starting, as IL-17 inhibition increases susceptibility to infections including mucocutaneous candidiasis.
• Avoid initiation during active serious infection and use caution in patients with inflammatory bowel disease, which may be triggered or worsened.
• Ensure vaccinations are up to date beforehand and avoid live vaccines during treatment.

Monitoring

Monitor clinically for signs of infection, for new or worsening inflammatory bowel disease symptoms, and for treatment response at the skin and joints.

Counselling the patient

• Report fevers, persistent sore throat, oral thrush or other signs of infection.
• Tell your clinician about any new or worsening bowel symptoms such as diarrhoea or abdominal pain.
• This is a self-injectable biologic; follow the injection technique you are taught and rotate sites.

Evidence & guidelines

Efficacy in plaque psoriasis was demonstrated in the UNCOVER phase 3 trial programme, and ixekizumab is recommended by NICE within its licensed indications.