IL-17 inhibitors
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Dosing and administration[2]
Subcutaneous; used mainly for psoriatic arthritis and axial spondyloarthritis. Secukinumab and ixekizumab block IL-17A; bimekizumab blocks both IL-17A and IL-17F, with more frequent oral candidiasis. Evaluate for latent tuberculosis before starting, and use caution in inflammatory bowel disease (IL-17 blockade can worsen IBD; bimekizumab is not recommended in IBD).
| Agent | Route | Dose and frequency |
|---|---|---|
| Secukinumab (Cosentyx) | Subcutaneous | Psoriatic arthritis: 150 mg at weeks 0, 1, 2, 3, and 4, then monthly. Consider 300 mg (given as two 150 mg injections) in anti-TNF inadequate responders or continued active disease; for coexistent moderate-to-severe plaque psoriasis use the psoriasis regimen (300 mg). Axial spondyloarthritis (ankylosing spondylitis and non-radiographic axSpA): 150 mg at weeks 0, 1, 2, 3, and 4, then monthly; in ankylosing spondylitis with continued active disease, consider 300 mg monthly. Response is usually seen within 16 weeks. |
| Ixekizumab (Taltz) | Subcutaneous | Psoriatic arthritis: 160 mg (two 80 mg injections) at week 0, then 80 mg every 4 weeks (use the psoriasis regimen if there is coexistent moderate-to-severe plaque psoriasis). Ankylosing spondylitis: 80 mg every 4 weeks; limited data suggest some TNF-experienced patients may benefit from a 160 mg starting dose. Non-radiographic axial spondyloarthritis: 80 mg every 4 weeks (no loading dose). |
| Bimekizumab (Bimzelx) | Subcutaneous | Psoriatic arthritis: 160 mg every 4 weeks. In PsA with coexistent moderate-to-severe plaque psoriasis, dose as for psoriasis (320 mg every 4 weeks through week 16, then every 8 weeks), reassess the joint response at 16 weeks, and switch to the PsA dose if joint control is not maintained. Axial spondyloarthritis (ankylosing spondylitis and non-radiographic axSpA): 160 mg every 4 weeks. Bimekizumab blocks both IL-17A and IL-17F; oral candidiasis is more frequent with this dual blockade than with IL-17A-only agents. Contraindicated in hypersensitivity to the drug or excipients; not recommended in inflammatory bowel disease; evaluate for tuberculosis before starting; avoid live vaccines. |
Onset. Onset over about 4 to 16 weeks.
Used mainly for psoriatic arthritis and axial spondyloarthritis rather than rheumatoid arthritis; regimens differ for plaque psoriasis.
Monitoring
- Screen for latent tuberculosis before starting.
- Caution in inflammatory bowel disease (IL-17 blockade can trigger or worsen IBD).
- Monitor for infection and mucocutaneous candidiasis.
Contraindications
- Active serious infection, including active tuberculosis.
- Active inflammatory bowel disease (relative).
Key interactions
- Do not combine with other biologic DMARDs or JAK inhibitors.
- Avoid live vaccines.
Clinical notes
Common side effects
Injection-site reactions, increased infection risk, and a higher rate of mucocutaneous candidiasis. Not sourced on this draft.
Tests and monitoring
Pre-treatment infection screening (including tuberculosis where indicated); ongoing vigilance for infection and for inflammatory bowel symptoms. Specific screening to confirm from primary sources.
Important cautions
Caution or avoidance in inflammatory bowel disease, which they can exacerbate; live-vaccine timing applies. To confirm from primary sources.
References
- Primary sources for general (non-pregnancy) use to be attached: product monograph and the relevant ACR/EULAR treatment guideline.
- Standard approved doses from the respective Health Canada product monographs: secukinumab (Cosentyx) and ixekizumab (Taltz). https://health-products.canada.ca/dpd-bdpp/