Taltz ® (ixekizumab)

This information is intended for UK registered healthcare professionals only as a scientific exchange in response to your search for information.For current prescribing information for all Lilly products, including Summaries of Product Characteristics, Patient Information Leaflets and Instructions for Use, please visit: www.medicines.org.uk (England, Scotland, Wales) or www.emcmedicines.com/en-GB/northernireland/ (Northern Ireland).

Can Taltz® (ixekizumab) be Used in Patients with Comorbid Tuberculosis?

Do not administer ixekizumab to patients with active TB infection. Initiate treatment of latent TB prior to administering ixekizumab.

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Summary

Ixekizumab is contraindicated in patients with clinically important active infections (e.g. active tuberculosis).1

Reactivation of latent TB infection (LTBI) has been reported with the use of other immunosuppressive agents.2,3

No confirmed cases of TB reactivation were reported in the ixekizumab clinical trials.

  • Integrated data from clinical trials of ixekizumab in adult patients with psoriasis, psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) showed no confirmed cases of TB reactivation.4,5

Treatment with ixekizumab is associated with an increased rate of infections such as upper respiratory tract infection, oral candidiasis, conjunctivitis, and tinea infections.1

Ixekizumab should be used with caution in patients with clinically important chronic infection or a history of recurrent infection. 1

Patients should be instructed to seek medical advice if signs or symptoms suggestive of an infection occur.1

If an infection develops,

  • patients should be carefully monitored and 
  • ixekizumab discontinued if
    • the patient is not responding to standard therapy or if
    • the infection becomes serious.1

Ixekizumab should not be resumed until the infection resolves.1

Tuberculosis Screening in Ixekizumab Clinical Trials

Patients were screened for TB using chest x-rays, purified protein derivative (PPD) skin tests, or QuantiFERON®-TB Gold.6,7 Patients who

  • tested negative were retested yearly, with the exception of axSpA trials, in which no retesting for TB was required
  • tested positive for TB but had no evidence of TB infection were allowed to participate in the trial if they received at least 4 weeks of appropriate LTBI therapy, with the completion of the therapy during the course of the study
  • had evidence or suspicion of active TB were excluded from ixekizumab clinical trials, and
  • had household contact with a person with active TB were excluded, unless appropriate and documented prophylaxis for TB was given.6-8

Treatment-Emergent Adverse Events of Tuberculosis from Ixekizumab Clinical Trials

17 Psoriasis Clinical Trials

In an integrated safety analysis of all ixekizumab adult psoriasis exposures (N=6892; 18,025.7 patient-years [PYs] of exposure) across 17 plaque psoriasis trials as of March 19, 2021, latent TB was reported in 106 (1.5%) patients (incidence rate [IR]=0.6 per 100 PYs). No confirmed cases of TB reactivation were reported.4

Opportunistic TB infection (using narrow Medical Dictionary for Regulatory Activities [MedDRA] preferred terms) was reported in 2 (0.0%) patients (pulmonary TB, n=1; TB, n=1).7

4 Psoriatic Arthritis Clinical Trials

In an integrated safety analysis of all ixekizumab PsA exposures (N=1401; 2247.7 PYs of exposure) across 4 PsA trials as of March 19, 2021, latent TB was reported in 35 (2.5%) patients (IR=1.6 per 100 PYs). No confirmed cases of TB reactivation were reported.5

No cases of opportunistic TB infection (using narrow MedDRA preferred terms) were reported.7

4 Axial Spondyloarthritis Clinical Trials

In an integrated safety analysis of all ixekizumab axSpA (including ankylosing spondylitis/radiographic axial spondyloarthritis [AS/r-axSpA] and nonradiographic axial spondyloarthritis [nr-axSpA]) exposures (N=932; 2096.2 PYs of exposure) across 4 axSpA trials as of March 19, 2021, latent TB was reported in 2 (0.2%) patients (IR=0.1 per 100 PYs). No confirmed cases of TB reactivation were reported.5

No cases of opportunistic TB infection (using narrow MedDRA preferred terms) were reported.7 

Post Hoc Analysis of Integrated Safety Data in Psoriasis and Psoriatic Arthritis Clinical Trials

A post hoc analysis of integrated safety data from 16 clinical trials in patients with psoriasis and PsA evaluated the incidence of treatment-emergent LTBI in patients who received ixekizumab. The analysis included data from 13 psoriasis clinical trials (N=5898; 16,313 PY) and 3 PsA clinical trials (N=1118; 1822 PY).9

Of the 5898 patients from the psoriasis clinical trials included in the analysis, 101 (1.7%) developed treatment-emergent LTBI. A total of 36 patients continued in the study, and 30 of those patients received LTBI treatment.9

Of the 1118 patients from the PsA clinical trials included in the analysis, 32 (2.9%) developed treatment-emergent LTBI. A total of 12 patients continued in the study, and 7 of those patients received LTBI treatment.9

No cases of reactivation of TB were identified in this safety analysis.9

References

1Taltz [summary of product characteristics]. Eli Lilly and Company (Ireland) Limited, Ireland

2Fallahi-Sichani M, Flynn JL, Linderman JJ, Kirschner DE. Differential risk of tuberculosis reactivation among anti-TNF therapies is due to drug binding kinetics and permeability. Immunol. 2012;188(7):3169-3178. http://dx.doi.org/10.4049/jimmunol.1103298

3Xie X, Li F, Chen JW, Wang J. Risk of tuberculosis infection in anti-TNF-α biological therapy: from bench to bedside. J Microbiol Immunol Infect. 2014;47(4):268-274. http://dx.doi.org/10.1016/j.jmii.2013.03.005

4Griffiths CEM, Gooderham M, Colombel JF, et al. Safety of ixekizumab in adult patients with moderate-to-severe psoriasis: data from 17 clinical trials with over 18,000 patient-years of exposure. Poster presented at: Annual Meeting of the American Academy of Dermatology (AAD); March 25-29, 2022; Boston, MA.

5Schwartzman S, Deodhar A, Combe B, et al. Safety profile of ixekizumab for the treatment of psoriatic arthritis and axial spondyloarthritis up to 3 years: an updated integrated safety analysis. Poster presented at: Annual Meeting of the America College of Rheumatology (ACR Convergence Virtual); November 1-10, 2021.

6Riedl E, Winkler S, Xu W, et al. No reactivation of tuberculosis in psoriasis patients with latent tuberculosis infection while on ixekizumab treatment: a report from 11 clinical studies. Abstract presented at: 27th Congress of the European Academy of Dermatology and Venereology; September 12-16, 2018; Paris, France.

7Data on file, Eli Lilly and Company and/or one of its subsidiaries.

8Gordon KB, Blauvelt A, Papp KA, et al; UNCOVER-1, UNCOVER-2, and UNCOVER-3 Study Groups. Phase 3 trials of ixekizumab in moderate-to-severe plaque psoriasis. N Engl J Med. 2016;375(4):345-356. http://dx.doi.org/10.1056/NEJMoa1512711

9Mrowietz U, Riedl E, Winkler S, et al. No reactivation of tuberculosis in patients with latent tuberculosis infection receiving ixekizumab: a report from 16 clinical studies of patients with psoriasis or psoriatic arthritis. J Am Acad Dermatol. 2020;83(5):1436-1439. https://doi.org/10.1016/j.jaad.2020.06.012

Date of Last Review: 08 March 2022


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