Ixekizumab

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Ixekizumab
Monoclonal antibody
Type Whole antibody
Source Humanized
Target Interleukin 17A (IL-17A)
Clinical data
Pronunciationix-ee-KIZ-ue-mab [1]
Trade names Taltz
AHFS/Drugs.com Monograph
MedlinePlus a616025
License data
Pregnancy
category
Routes of
administration 		Subcutaneous injection
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability 60–81% [7]
Metabolism Presumably proteolysis
Elimination half-life 13 days [8]
Identifiers
CAS Number
DrugBank
ChemSpider
  • none
UNII
KEGG
ChEMBL
Chemical and physical data
Formula C6492H10012N1728O2028S46
Molar mass 146192.34 g·mol−1
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Ixekizumab, sold under the brand name Taltz, is an injectable medication for the treatment of autoimmune diseases. Chemically, it is a form of a humanized monoclonal antibody. [9] The substance acts by binding interleukin 17A and neutralizing it, reducing inflammation. [10] [11]

Contents

The most common side effects include upper respiratory infections, injection site reactions and fungal (tinea) infections. [12]

The drug was developed by Eli Lilly and Co. and is approved for the treatment of plaque psoriasis in the European Union and the United States as of 2016. [6] [13]

Medical uses

In the United States, ixekizumab is indicated for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy, active psoriatic arthritis, active ankylosing spondylitis, and active non-radiographic axial spondyloarthritis with objective signs of inflammation. [14] In the European Union it is indicated for the treatment of moderate-to-severe plaque psoriasis [6] and as a second-line therapy for active psoriatic arthritis. [6] [10]

In studies, the drug reduced the Psoriasis Area and Severity Index by at least 75% (PASI75) in 82–89% of patients during the first three months of treatment (depending on the dosing scheme), and 40% of patients experienced a complete absence of psoriasis symptoms (PASI100). In the placebo group, PASI75 was reached in 4% of patients, and PASI100 in none; in the group of patients receiving etanercept, an older anti-psoriasis drug, PASI75 was reached in 48%. Until the 60th study week, 11–44% of ixekizumab treated patients relapsed (again, depending on the dosing scheme), as compared to 84% under placebo. [10] [15]

Contraindications

The medication is contraindicated for patients with certain infections such as active tuberculosis. [10] [ contradictory ]

Adverse effects

In studies, ixekizumab increased the rate of infections (27% of ixekizumab treated patients, compared to 23% under placebo), including severe ones (0.6% versus 0.4% under placebo). Other common side effects included injection site reactions such as redness and pain (13–17% versus 3%), [16] oropharyngeal pain (1%) and nausea (1–2%). [10] Other common adverse effects (≥5.0%) include nasopharyngitis, upper respiratory tract infection, arthralgia, headache, back pain, hypertension, bronchitis, diarrhea, sinusitis, and urinary tract infection. [17]

In a review of 18,025 patient years (n=6892 patients), no anaphylaxis was reported, no reactivation of tuberculosis, and low incidence rate of candida infection and serious infections was found. Incidence rates decreased or remained constant over time. [17]

Ixekizumab does not have an increased risk of adverse effects in the elderly. [18]

Overdose

Up to fourfold doses have been given in studies without causing serious side effects. [10]

Interactions

No interaction studies have been done. Ixekizumab and interleukin 17 are not known to interact with cytochrome P450 (CYP) liver enzymes. Since inflammation suppresses CYP activity, it is theorized that ixekizumab could neutralize this effect and lower blood plasma concentrations of drugs that are metabolized by CYP enzymes, such as warfarin. [10]

Pharmacology

Mechanism of action

Ixekizumab binds to interleukin 17 (IL-17A), a pro-inflammatory cytokine, and blocks its action. Among other things, IL-17A stimulates proliferation and activation of keratinocytes in the skin. [10] This mechanism is similar to that of another anti-psoriasis antibody, brodalumab, which binds to the interleukin-17 receptor. [19]

The antibody has affinity to the homodimer IL-17A and the heterodimer IL-17A/F, but not to other members of the interleukin 17 family. [10]

Pharmacokinetics

After subcutaneous injection, ixekizumab has a bioavailability of 60–81%; [7] bioavailability is higher in the thigh than the abdomen or arm. [7] Highest blood plasma concentrations are reached after four to seven days after a single dose. [8] With the usual dosing scheme (loading plus a dose every two weeks), steady state concentrations are reached in the eighth week on average. [10]

Like other antibodies, ixekizumab is probably degraded by proteolysis. Its elimination half-life is 14–18 days. [10] [20] The volume of distribution is 7.11 L. [8] Mean clearance is 0.39 L/day. [8] There is no difference in rate of clearance between elderly and younger patients. [18] Increased body weight increases the volume of distribution and clearance rate. [8] Ixekizumab displays linear pharmacokinetics across doses. [20]

Pharmacokinetic data is similar for autoinjector pens and prefilled syringes. [7]

Chemistry

Ixekizumab is a complete monoclonal antibody of the subclass IgG4, consisting of two light chains and two heavy chains linked by disulfide bridges. Both heavy chains are glycosylated at the asparagine in position 296. In the hinge region, a serine is replaced by a proline to reduce formation of half-antibodies and heterodimers in the manufacturing process. The terminal lysine found in wild-type IgG4 is removed. The antibody is produced in Chinese hamster ovary cells. [9] [21]

History

Clinical trials included a Phase II trial of patients with moderate to severe psoriasis, [19] and a Phase III open-label trial. [22] [ full citation needed ]

Ixekizumab was approved by the US Food and Drug Administration (FDA) in March 2016, for the treatment of adults with moderate-to-severe plaque psoriasis [12] and by the European Medicines Agency (EMA) in April 2016. [6] The safety and efficacy of ixekizumab were established in three randomized, placebo-controlled clinical trials with a total of 3,866 participants with plaque psoriasis who were candidates for systemic or phototherapy therapy. [12] The FDA approved ixekizumab based on the evidence from three clinical trials of 1958 participants with moderate to severe psoriasis. [23] The trials were conducted in the US, Canada, Europe, Russia, Mexico, Chile, Argentina, Japan and Australia. [23]

In December 2017, the FDA approved it for active psoriatic arthritis. [24]

Related Research Articles

<span class="mw-page-title-main">Psoriasis</span> Skin disease

Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete body coverage. Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon.

<span class="mw-page-title-main">Infliximab</span> Biopharmaceutical drug for autoimmune disorders

Infliximab, a chimeric monoclonal antibody, sold under the brand name Remicade among others, is a medication used to treat a number of autoimmune diseases. This includes Crohn's disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, and Behçet's disease. It is given by slow injection into a vein, typically at six- to eight-week intervals.

<span class="mw-page-title-main">Psoriatic arthritis</span> Long-term inflammatory arthritis

Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that occurs in people affected by the autoimmune disease psoriasis. The classic feature of psoriatic arthritis is swelling of entire fingers and toes with a sausage-like appearance. This often happens in association with changes to the nails such as small depressions in the nail (pitting), thickening of the nails, and detachment of the nail from the nailbed. Skin changes consistent with psoriasis frequently occur before the onset of psoriatic arthritis but psoriatic arthritis can precede the rash in 15% of affected individuals. It is classified as a type of seronegative spondyloarthropathy.

Adalimumab, sold under the brand name Humira and others, is a disease-modifying antirheumatic drug and monoclonal antibody used to treat rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, plaque psoriasis, hidradenitis suppurativa, and uveitis. It is administered by subcutaneous injection. It works by inactivating tumor necrosis factor-alpha (TNFα).

A TNF inhibitor is a pharmaceutical drug that suppresses the physiologic response to tumor necrosis factor (TNF), which is part of the inflammatory response. TNF is involved in autoimmune and immune-mediated disorders such as rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, psoriasis, hidradenitis suppurativa and refractory asthma, so TNF inhibitors may be used in their treatment. The important side effects of TNF inhibitors include lymphomas, infections, congestive heart failure, demyelinating disease, a lupus-like syndrome, induction of auto-antibodies, injection site reactions, and systemic side effects.

Biological response modifiers (BRMs) are substances that modify immune responses. They can be endogenous or exogenous, and they can either enhance an immune response or suppress it. Some of these substances arouse the body's response to an infection, and others can keep the response from becoming excessive. Thus they serve as immunomodulators in immunotherapy, which can be helpful in treating cancer and in treating autoimmune diseases, such as some kinds of arthritis and dermatitis. Most BRMs are biopharmaceuticals (biologics), including monoclonal antibodies, interleukin 2, interferons, and various types of colony-stimulating factors. "Immunotherapy makes use of BRMs to enhance the activity of the immune system to increase the body's natural defense mechanisms against cancer", whereas BRMs for rheumatoid arthritis aim to reduce inflammation.

Ustekinumab, sold under the brand name Stelara among others, is a monoclonal antibody medication developed by Janssen Pharmaceuticals, for the treatment of Crohn's disease, ulcerative colitis, plaque psoriasis and psoriatic arthritis, targeting both IL-12 and IL-23.

Tocilizumab, sold under the brand name Actemra among others, is an immunosuppressive drug, used for the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis, polyarticular juvenile idiopathic arthritis, giant cell arteritis, cytokine release syndrome, COVID‑19, and systemic sclerosis-associated interstitial lung disease (SSc-ILD). It is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R). Interleukin 6 (IL-6) is a cytokine that plays an important role in immune response and is implicated in the pathogenesis of many diseases, such as autoimmune diseases, multiple myeloma and prostate cancer. Tocilizumab was jointly developed by Osaka University and Chugai, and was licensed in 2003 by Hoffmann-La Roche.

<span class="mw-page-title-main">Interleukin-17A</span> Protein-coding gene in the species Homo sapiens

Interleukin-17A is a protein that in humans is encoded by the IL17A gene. In rodents, IL-17A used to be referred to as CTLA8, after the similarity with a viral gene.

Briakinumab (ABT-874) is a human monoclonal antibody being developed by Abbott Laboratories for the treatment of rheumatoid arthritis, inflammatory bowel disease, and multiple sclerosis. As of 2011 drug development for psoriasis has been discontinued in the U.S. and Europe.

<span class="mw-page-title-main">Tofacitinib</span> Medication

Tofacitinib, sold under the brand Xeljanz among others, is a medication used to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polyarticular course juvenile idiopathic arthritis, and ulcerative colitis. It is a janus kinase (JAK) inhibitor, discovered and developed by the National Institutes of Health and Pfizer.

<span class="mw-page-title-main">Secukinumab</span> Monoclonal antibody against IL-17

Secukinumab, sold under the brand name Cosentyx among others, is a human IgG1κ monoclonal antibody used for the treatment of psoriasis, ankylosing spondylitis, and psoriatic arthritis. It binds to the protein interleukin (IL)-17A and is marketed by Novartis.

Olokizumab (OKZ) sold under the name Artlegia, is an immunosuppressive drug, used for the treatment of rheumatoid arthritis and COVID-19. It is a humanized monoclonal antibody against the interleukin-6 (IL-6). IL-6 is a cytokine that plays an important role in immune response and is implicated in the pathogenesis of many diseases. Olokizumab is the first interleukin-6 (IL-6) inhibitor approved for treatment of rheumatoid arthritis which blocks directly cytokine instead of its receptor. Olokizumab specifically binds to IL-6 at Site 3, blocking IL-6 ability to form hexameric complex. Olokizumab was developed by R-Pharm group, and was launched in 2020.

<span class="mw-page-title-main">Apremilast</span> Medication for psoriasis and psoriatic arthritis

Apremilast, sold under the brand name Otezla among others, is a medication for the treatment of certain types of psoriasis and psoriatic arthritis. The drug acts as a selective inhibitor of the enzyme phosphodiesterase 4 (PDE4) and inhibits spontaneous production of TNF-alpha from human rheumatoid synovial cells. It is taken by mouth.

<span class="mw-page-title-main">Dupilumab</span> Drug used to treat allergic diseases

Dupilumab, sold under the brand name Dupixent, is a monoclonal antibody blocking interleukin 4 and interleukin 13, used for allergic diseases such as atopic dermatitis (eczema), asthma and nasal polyps which result in chronic sinusitis. It is also used for the treatment of eosinophilic esophagitis and prurigo nodularis.

Tildrakizumab, sold under the brand name Ilumya among others, is a monoclonal antibody designed for the treatment of immunologically mediated inflammatory disorders. It is approved for the treatment of adults with moderate-to-severe plaque psoriasis in the United States and in the European Union.

Guselkumab, sold under the brand name Tremfya, is a monoclonal antibody against interleukin-23 used for the treatment of plaque psoriasis.

Risankizumab, sold under the brand name Skyrizi, is a humanized monoclonal antibody used for the treatment of plaque psoriasis, psoriatic arthritis, and Crohn's disease. It is designed to target interleukin 23A (IL-23A). It is given by subcutaneous injection.

<span class="mw-page-title-main">Upadacitinib</span> Chemical compound (medication)

Upadacitinib, sold under the brand name Rinvoq, is a medication used for the treatment of rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, ulcerative colitis, Crohn's disease, ankylosing spondylitis, and axial spondyloarthritis. Upadacitinib is a Janus kinase (JAK) inhibitor that works by blocking the action of enzymes called Janus kinases. These enzymes are involved in setting up processes that lead to inflammation, and blocking their effect brings inflammation in the joints under control.

Bimekizumab, sold under the brand name Bimzelx, is a humanized anti-IL17A, anti-IL-17F, and anti-IL17AF monoclonal antibody that is used to treat plaque psoriasis, psoriatic arthritis, axial spondyloarthritis, and ankylosing spondylitis.

References

  1. ↑ "12 Difficult-to-Pronounce Drug Names". Pharmacy Times. 7 February 2018. Archived from the original on 21 March 2018. Retrieved 22 March 2018.
  2. ↑ "Ixekizumab (Taltz) Use During Pregnancy". Drugs.com. 27 November 2019. Retrieved 27 March 2020.
  3. ↑ "Prescription medicines: registration of new chemical entities in Australia, 2016". Therapeutic Goods Administration (TGA). 21 June 2022. Retrieved 10 April 2023.
  4. ↑ "Health Canada New Drug Authorizations: 2016 Highlights". Health Canada . 14 March 2017. Retrieved 7 April 2024.
  5. ↑ "Taltz 80 mg solution for injection in pre-filled syringe - Summary of Product Characteristics (SmPC)". (emc). 21 August 2019. Retrieved 27 March 2020.
  6. 1 2 3 4 5 "Taltz EPAR". European Medicines Agency (EMA). 2 May 2016. Retrieved 27 March 2020.
  7. 1 2 3 4 Vu TT, Gooderham M, Papp K (November 2016). "Ixekizumab for treatment of adults with moderate-to-severe plaque psoriasis and psoriatic arthritis". Expert Review of Clinical Pharmacology. 9 (11): 1423–1433. doi:10.1080/17512433.2016.1242409. PMID   27690669.
  8. 1 2 3 4 5 Kiwalkar S, Beier S, Deodhar A (October 2019). "Ixekizumab for treating ankylosing spondylitis". Immunotherapy. 11 (15): 1273–1282. doi:10.2217/imt-2019-0094. PMID   31530049.
  9. 1 2 "Statement On A Nonproprietary Name Adopted By The USAN Council: Ixekizumab" (PDF). American Medical Association.
  10. 1 2 3 4 5 6 7 8 9 10 11 Haberfeld H, ed. (2015). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag.
  11. ↑ Cai Y, Fleming C, Yan J (July 2013). "Dermal γδ T cells--a new player in the pathogenesis of psoriasis". International Immunopharmacology. 16 (3): 388–391. doi:10.1016/j.intimp.2013.02.018. PMID   23499509.
  12. 1 2 3 "FDA approves new psoriasis drug Taltz". U.S. Food and Drug Administration (FDA) (Press release). 22 March 2016. Retrieved 27 March 2020.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  13. ↑ "Taltz (ixekizumab) Injection". U.S. Food and Drug Administration (FDA). 3 May 2016. Retrieved 27 March 2020.
  14. ↑ "Taltz- ixekizumab injection, solution". DailyMed. 23 August 2019. Retrieved 27 March 2020.
  15. ↑ Klement A (4 June 2016). "Taltz". Österreichische Apothekerzeitung (in German) (14/2016): 12.
  16. ↑ Shear NH, Paul C, Blauvelt A, Gooderham M, Leonardi C, Reich K, et al. (February 2018). "Safety and Tolerability of Ixekizumab: Integrated Analysis of Injection-Site Reactions from 11 Clinical Trials". Journal of Drugs in Dermatology. 17 (2): 200–206. PMID   29462229.
  17. 1 2 Griffiths CE, Gooderham M, Colombel JF, Terui T, Accioly AP, Gallo G, et al. (June 2022). "Safety of Ixekizumab in Adult Patients with Moderate-to-Severe Psoriasis: Data from 17 Clinical Trials with Over 18,000 Patient-Years of Exposure". Dermatology and Therapy. 12 (6): 1431–1446. doi:10.1007/s13555-022-00743-9. PMC   9209552 . PMID   35624407.
  18. 1 2 Di Lernia V, Goldust M (August 2018). "An overview of the efficacy and safety of systemic treatments for psoriasis in the elderly". Expert Opinion on Biological Therapy. 18 (8): 897–903. doi:10.1080/14712598.2018.1504016. PMID   30032682.
  19. 1 2 "Neue Antikörper in der Pipeline". Pharmazeutische Zeitung (in German) (12). 2012.
  20. 1 2 Dyring-Andersen B, Skov L, Zachariae C (April 2015). "Ixekizumab for treatment of psoriasis". Expert Review of Clinical Immunology. 11 (4): 435–442. doi:10.1586/1744666X.2015.1023295. PMID   25748485.
  21. ↑ "Assessment report: Taltz" (PDF). European Medicines Agency. 25 February 2016. p. 7.
  22. ↑ Clinical trial number NCT01624233 for "A Study in Japanese Participants With Moderate-to-Severe Psoriasis" at ClinicalTrials.gov
  23. 1 2 "Drug Trials Snapshots: Taltz". U.S. Food and Drug Administration (FDA). 22 March 2016. Retrieved 24 September 2020.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  24. ↑ "FDA approves Taltz for psoriatic arthritis in adults". Healio. 4 December 2017. Retrieved 23 September 2020.
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