IL-17 Inhibitors

Administration: Subcutaneous injection

Dose:

• 160mg (two 80mg injections) at week 0, then 80mg every 4 weeks
• For concomitant moderate to severe plaque psoriasis - 160mg (two 80mg injections) at week 0, followed by 80mg (one injection) at weeks 2, 4, 6, 8, 10, and 12, then maintenance dosing of 80mg every 4 weeks

Time to response: 2 weeks to 3 months

Indications:

• Psoriatic Arthritis.
• Ankylosing Spondylitis.
• Non-Radiographic Spondyloarthropathies.

Contraindications:

• Pregnancy & breast feeding.
• Active infection.
• Active TB.
• Severe hypersensitivity reactions to the active substance or to any of the excipients.

Cautions:

• Inflammatory bowel disease.
• Latex sensitive individuals.

Monitoring:

• FBC, U&E, LFTs after 3 months, then 6 monthly

Vaccinations:

• Avoid live attenuated vaccines.
• Offer annual influenza vaccination.
• In those who are biologic naïve pneumococcal vaccination and Sars-Cov-2 vaccination should ideally be performed at least 2 weeks before commencing biologic treatment.
• Assuming no contraindications before starting treatment:
  • Patients >50 should undergo vaccination against HZV.
  • Those who are varicella zoster negative should be offered varicella vaccination.

In the event of:

• Injection site reaction – usually settles without further intervention.
• Sore throat/fever/bruising/pallor – stop IXEKIZUMAB and check FBC.
• Serious infection – stop IXEKIZUMAB and restart once infection resolved.
• Surgery – stop 1 week prior to surgery and resume after wound healing.
• Increasing dyspnoea – stop IXEKIZUMAB and arrange CXR.
• Stop IXEKIZUMAB at least 10 weeks before female patients attempt to conceive.

Stop IXEKIZUMAB if:

• WBC < 3.5 x10⁹/L
• ALT/AST > two times normal
• Neutrophils < 2.0 x 10⁹/l
• Platelets <150 x 10⁹/l

Administration: Subcutaneous injection

Dose: 150mg or 300 mg, after first dose (week 0), further weekly injections at week 1,2, and 3. From week 4 - monthly injections. The 300 mg dose is given as two 150 mg injections. 

Time to response: 2 weeks to 3 months

Indications:

• Psoriatic Arthritis.
• Ankylosing Spondylitis.
• Non-Radiographic Spondyloarthropathies.

Contraindications:

• Pregnancy & breast feeding.
• Active infection.
• Active TB.
• Severe hypersensitivity reactions to the active substance or to any of the excipients.

Cautions:

• Crohn’s disease.
• Latex sensitive individuals.

Monitoring:

• FBC, U&E, LFTs after 3 months, then 6 monthly

Vaccinations:

• Avoid live attenuated vaccines.
• Offer annual influenza vaccination.
• In those who are biologic naïve pneumococcal vaccination and Sars-Cov-2 vaccination should ideally be performed at least 2 weeks before commencing biologic treatment.
• Assuming no contraindications before starting treatment:
  • Patients >50 should undergo vaccination against HZV.
  • Those who are varicella zoster negative should be offered varicella vaccination.

In the event of:

• Injection site reaction – usually settles without further intervention.
• Sore throat/fever/bruising/pallor – stop SECUKINUMAB and check FBC.
• Serious infection – stop SECUKINUMAB and restart once infection resolved.
• Surgery – stop 1 week prior to surgery and resume after wound healing.
• Increasing dyspnoea – stop SECUKINUMAB and arrange CXR.
• Stop SECUKINUMAB 20 weeks before female patients attempt to conceive.

Stop SECUKINUMAB if:

• WBC < 3.5 x10⁹/L
• ALT/AST > two times normal
• Neutrophils < 2.0 x 10⁹/l
• Platelets <150 x 10⁹/l