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IL-17A Inhibitor — Psoriasis Pregnancy: Avoid — limited data; IgG crosses placenta; avoid in pregnancy and for 10 weeks after last dose

Ixekizumab

Brand names: Taltz

Adult dose

Dose: 160 mg SC (two 80 mg injections) at week 0, then 80 mg at weeks 2, 4, 6, 8, 10, 12 (induction), then 80 mg every 4 weeks (maintenance)
Route: SC injection
Frequency: Every 2 weeks (induction) then every 4 weeks (maintenance)
Max: 80 mg per dose (maintenance)
IL-17A inhibitor for moderate-to-severe plaque psoriasis, psoriatic arthritis, and axial spondyloarthritis. Faster onset than IL-12/23 inhibitors (ustekinumab) — clear skin achievable within 12 weeks. Available as auto-injector pen or prefilled syringe.

Paediatric dose

Dose: Weight-based: <25 kg 40 mg; 25–50 kg 80 mg; >50 kg 160 mg (induction) mg/kg
Route: SC
Frequency: Every 4 weeks (maintenance)
Max: 160 mg induction; 80 mg maintenance
BNFc: licensed for paediatric plaque psoriasis ≥6 years. Weight-based dosing — follow prescribing information carefully.

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

BNFc: licensed for paediatric plaque psoriasis ≥6 years. Weight-based dosing — follow prescribing information carefully.

Clinical pearls

  • UNCOVER-1, -2, -3 trials: ixekizumab achieved PASI 90 in ~70% of patients at week 12 — superior to etanercept; fast onset is a key differentiator
  • Mucocutaneous candidiasis: IL-17A is critical for mucosal antifungal immunity — candidiasis (oral, genital) occurs in ~3% of patients; usually mild and treated with standard antifungals without stopping ixekizumab
  • IBD caution: IL-17A inhibitors may worsen Crohn's disease — avoid in active IBD; monitor for new GI symptoms during treatment
  • TB screening mandatory before initiating (IGRA or Mantoux + CXR) — as per all biologics
  • NICE TA442: ixekizumab recommended for moderate-to-severe plaque psoriasis after failure of conventional systemic therapy
  • Faster onset vs ustekinumab: ixekizumab produces significant skin clearance within 4 weeks — preferred when rapid response needed (e.g. prior to planned event)

Contraindications

  • Active infection (including TB — screen before initiating)
  • Hypersensitivity to ixekizumab
  • Inflammatory bowel disease (use with caution — may exacerbate Crohn's)

Side effects

  • Injection site reactions
  • Nasopharyngitis
  • Upper respiratory tract infections
  • Tinea infections (candidiasis)
  • Neutropenia
  • Inflammatory bowel disease exacerbation
  • Hypersensitivity reactions

Interactions

  • Live vaccines — avoid during treatment
  • CYP450 substrates — IL-17 inhibition normalises CYP enzyme activity; monitor narrow TI drugs (warfarin, ciclosporin)

Monitoring

  • PASI score at 16 weeks (NICE response criterion: ≥75% reduction)
  • Infection surveillance
  • IBD symptoms
  • Candidiasis

Reference: BNFc; BNF 90; BNFc; UNCOVER-2 Trial (Griffiths et al. NEJM 2015); NICE TA442; SPC Taltz. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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