Taltz® (ixekizumab): What is the guidance in patients undergoing surgical procedures?

General Recommendations for Biologic Therapies

The information provided is for reference only and does not constitute a treatment recommendation. Health care decisions to prescribe ixekizumab should be based on the best clinical judgment of the prescribing healthcare practitioner.

In general, psoriasis treatment guidelines from the British Association of Dermatologists recommend stopping biologic therapy for at least four half-lives prior to major elective surgical procedures, and restarting biologic treatments postoperatively, provided that wound healing is satisfactory and there is no evidence of infection.^1,2

In general, the American College of Rheumatology and American Association of Hip and Knee Surgeons recommend stopping biologic medications prior to surgery and scheduling surgery at the end of the dosing cycle. It is also recommended to resume medications at minimum 14 days after surgery in the absence of wound healing problems, surgical site infection, or systemic infection.³

Ixekizumab Label Information

The mean elimination half-life is 13 days in patients with plaque psoriasis, psoriatic arthritis, radiographic axial spondyloarthritis and non-radiographic axial spondyloarthritis.⁴

Treatment with ixekizumab is associated with an increased rate of infections such as upper respiratory tract infection, oral candidiasis, conjunctivitis, and tinea infections.⁴

Ixekizumab should be used with caution in patients with clinically important chronic infection or a history of recurrent infection. Patients should be instructed to seek medical advice if signs or symptoms suggestive of an infection occur. If an infection develops, monitor carefully and discontinue ixekizumab if the patient is not responding to standard therapy or the infection becomes serious. Ixekizumab should not be resumed until the infection resolves.⁴

References

1. Smith CH, Anstey AV, Barker JN, et al. British Association of Dermatologists’ guidelines for biologic interventions for psoriasis 2009. Br J Dermatol. 2009;161(5):987-1019. http://dx.doi.org/10.1111/j.1365-2133.2009.09505.x

2. Bakkour W, Purssell H, Chinoy H, et al. The risk of post-operative complications in psoriasis and psoriatic arthritis patients on biologic therapy undergoing surgical procedures. J Eur Acad Dermatol Venereol. 2016;30(1):86-91. http://dx.doi.org/10.1111/jdv.12997

3. Goodman SM, Springer B, Guyatt G, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. Arthritis Care Res (Hoboken). 2017;69(8):1111-1124. http://dx.doi.org/10.1002/acr.23274

4. Taltz [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.

Glossary

axSpA = axial spondyloarthritis

PsA = psoriatic arthritis