Taltz ® (ixekizumab) injektion

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Taltz® (ixekizumab): Pediatrisk psoriasis - biverkningar av Inflammatoriska tarmsjukdomar

Pediatrisk psoriasis är associerad med en ökad frekvens av Crohns sjukdom. Förekomsten av inflammatorisk tarmsjukdom i den kliniska prövningen av ixekizumab hos barn psoriasis sammanfattas nedan.

Ixekizumab Label Information Related to Inflammatory Bowel Disease

Cases of new or exacerbations of inflammatory bowel disease have been reported with ixekizumab. Ixekizumab is not recommended in patients with inflammatory bowel disease. If a patient develops signs and symptoms of inflammatory bowel disease or experiences an exacerbation of pre-existing inflammatory bowel disease, ixekizumab should be discontinued and appropriate medical management should be initiated.1

The safety profile observed in children with plaque psoriasis treated with ixekizumab every 4 weeks is consistent with the safety profile in adult patients with plaque psoriasis with the exception of the frequencies of conjunctivitis, influenza, and urticaria which were common.1

Inflammatory bowel disease was also more frequent in paediatric patients, although it was still uncommon. In the paediatric clinical study, Crohn’s disease occurred in 0.9% of patients in the ixekizumab group and 0% of patients in the placebo group during the 12‑week, placebo-controlled period. Crohn’s disease occurred in a total of 4 ixekizumab treated subjects (2.0%) during the combined placebo-controlled and maintenance periods of the paediatric clinical study.1

Prevalence of Inflammatory Bowel Disease In Pediatric Psoriasis Patients

The US Kaiser Permanente Northern California IBD Registry analyzed the average annual standardized CD incidence per 100 PY from 1996 to 2006, which by age was

  • 0.0004 for 0- to 4-years of age

  • 0.0013 for 5- to 9-years of age

  • 0.004 for 10- to 14-years or age, and

  • 0.0064 for 15- to 17-years of ages.2

Globally, the rates of pediatric IBD, due primarily to the incidence of CD, are rising; however, most countries lack accurate estimates of prevalence and incidence of pediatric IBD. Of 25 studies that calculated pediatric CD incidence over time, 60% reported statistically significant increased incidence of pediatric CD.3

Pediatric psoriasis is associated with an increased rate of CD.4

In a study using a German health insurance database, CD occurred 3-4 times more often in pediatric psoriasis patients compared to pediatric controls without psoriasis.4

Another retrospective United States claims study found the IR for IBD to be 0.118 per 100 PY in pediatric psoriasis patients vs 0.043 for the non-psoriasis pediatric cohort. Additionally, the IR for CD was 0.097 per 100 PY in the pediatric psoriasis cohort vs 0.029 for the non-psoriasis pediatric cohort.5

Inflammatory Bowel Disease Events in IXORA-PEDS

IXORA-PEDS is an ongoing, multicenter, randomized, double-blind, placebo-controlled phase 3 study designed to evaluate the efficacy and safety of ixekizumab in pediatric patients aged 6 to <18 years with moderate-to-severe plaque psoriasis.6

Patients with a history of IBD were not excluded from IXORA-PEDS. However, patients with a presence of a gastrointestinal disorder (not specifically IBD) at screening that, in the opinion of the investigator, posed an unacceptable risk to the patient if participating in the study or of interfering with the interpretation of data were excluded from IXORA-PEDS.7 

An independent external review committee of gastroenterologists with expertise in IBD adjudicated all potential AEs of IBD identified by IBD-related broad MedDRA search terms. This adjudication was prespecified in the IXORA-PEDS protocol.7

Adjudicated cases of IBD reported in the IXORA-PEDS trial are summarized in Table 1. The EAIR of IBD in IXORA-PEDS at the November 2019 48-week interim database lock is 1.6 per 100 PY.7 IXORA-PEDS is an ongoing study and the November 2019 database lock represents a total ixekizumab exposure of 253.9 PY.6

Across the entire ixekizumab psoriasis program, including 13 adult trials and IXORA-PEDS (N=6094), as of the March 2019 database lock for adults and November 2019 database lock for pediatrics, the frequency of adjudicated IBD was 0.5% corresponding to an EAIR of 0.2 per 100 PY.7

Table 1. IXORA-PEDS: Adjudicated Inflammatory Bowel Disease Adverse Events6,8

 

12-Week Double-Blind Treatment Period

Combined Treatment Periods
Through November 2019
a

 

Placebo
N=56
n (%)

Ixekizumab Q4W
N=115
n (%)

Total Ixekizumab
N=196
n (%)

Crohn's disease

0

1 (0.9)

4 (2.0)

Ulcerative colitis

0

0

0

Abbreviations: PY = patient-years; Q4W = every 4 weeks

a All patients exposed to ixekizumab in the induction, maintenance, and extension periods through the 48-week interim database lock (253.9 total PY of exposure), including patients switched to ixekizumab from placebo or etanercept following the double-blind induction treatment period.

Case summaries of the patients with IBD events are provided in Table 2.6

Table 2. IXORA-PEDS: Case Summaries of Patients With Adjudicated Inflammatory Bowel Disease6

Patient Demographics

Preferred Term
(Adjudication)

Risk Factors

Study Period, Treatment

Outcome

9 year old female

Diarrhea
(probable CD)

Gastrointestinal inflammation and abdominal pain at day 1

Double-blind treatment period day 43,
IXE Q4W

Discontinued, AE of gastrointestinal inflammation not resolved

15 year old male

IBD
(probable CD)

None reported

Maintenance period day 281, 
IXE Q4W

Discontinued, SAE recovered 

13 year old female

CD
(probable CD)

None reported

Maintenance period days 248 and 255, 
IXE Q4W

Discontinued, AE ongoing at time of database lock

9 year old female

CD
(probable CD)

History of alopecia areata, atopic dermatitis, and psoriatic arthritis

Maintenance period days 151, 172, and 177 and Post-treatment period day 118, 
IXE Q4W

Discontinued, patient recovered from each event

Abbreviations: AE = adverse event; CD = Crohn's disease; IBD = inflammatory bowel disease; IXE = ixekizumab; Q4W= every 4 weeks; SAE = serious adverse event.

References

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

2. Abramson O, Durant M, Mow W, et al. Incidence, prevalence, and time trends of pediatric inflammatory bowel disease in northern California, 1996 to 2006. J Pediatr. 2010;157(2):233-239.e231. http://dx.doi.org/10.1016/j.jpeds.2010.02.024

3. Benchimol EI, Fortinsky KJ, Gozdyra P, et al. Epidemiology of pediatric inflammatory bowel disease: A systematic review of international trends. Inflamm Bowel Dis. 2011;17(1):423-439. http://dx.doi.org/10.1002/ibd.21349

4. Augustin M, Glaeske G, Radtke MA, et al. Epidemiology and comorbidity of psoriasis in children. Br J Dermatol. 2010;162(3):633-636. http://dx.doi.org/10.1111/j.1365-2133.2009.09593.x

5. Paller AS, Schenfeld J, Accortt NA and Kricorian G. A retrospective cohort study to evaluate the development of comorbidities, including psychiatric comorbidities, among a pediatric psoriasis population. Pediatr Dermatol. 2019;36(3):290-297. http://dx.doi.org/10.1111/pde.13772

6. Paller AS, Seyger MMA, Magariños GA, et al. Efficacy and safety of ixekizumab in a phase 3, randomized, double-blind, placebo-controlled study in paediatric patients with moderate-to-severe plaque psoriasis (IXORA-PEDS). Br J Dermatol. Published online April 21, 2020. https://doi.org/10.1111/bjd.19147

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

8. Paller AS, Seyger MMB, Magariños GA, et al. Efficacy and safety of ixekizumab in a phase 3, randomized, double-blind, placebo-controlled study in pediatric patients with moderate-to-severe plaque psoriasis. Talk presented at: 28th Annual Meeting of the European Academy of Dermatology and Venereology; October 9-13, 2019; Madrid, Spain.

Glossary

AE = adverse event

CD = Crohn's disease

EAIR = exposure adjusted incidence rate

IBD = inflammatory bowel disease

IR = incidence rate

MedDRA = Medical Dictionary for Regulatory Activities

PY = patient-years

UC = ulcerative colitis

Datum fӧr senaste ӧversyn 2020 M05 05


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