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Taltz ® (ixekizumab)
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Taltz® (ixekizumab): Discontinue before surgery?
Safety and efficacy of ixekizumab in patients who undergo surgical procedures is undetermined since no formal studies have been performed.
Treatment Guidelines for Biologic Therapies
In general, psoriasis treatment guidelines from the British Association of Dermatologists recommend stopping biologic therapy for at least 4 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
The mean half-life for ixekizumab is 13 days in patients with plaque psoriasis.3 Four half-lives would equal approximately 7.4 weeks.
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.4
Ixekizumab dosing in psoriatic arthritis is every 4 weeks. Following these guidelines, a patient would be eligible for surgery on the fifth week after the last dose of ixekizumab. Similar guidance would apply for axial spondyloarthritis for which the dosing is every 4 weeks as well.5
If a patient has concurrent moderate-to-severe psoriasis, ixekizumab dosing is every 2 weeks during the 12-week induction period.5 Following these guidelines, a patient would be eligible for surgery on the 3rd week after the last dose of ixekizumab.
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.
Ixekizumab Label Information
The mean elimination half-life, as estimated from population pharmacokinetic analysis, is 13 days in patients with plaque psoriasis.3
- The pharmacokinetic properties of ixekizumab were similar across the plaque psoriasis, psoriatic arthritis, radiographic axial spondyloarthritis and non-radiographic axial spondyloarthritis indications.3
Treatment with ixekizumab is associated with an increased rate of infections such as upper respiratory tract infection, oral candidiasis, conjunctivitis, and tinea infections.3
Ixekizumab should be used with caution in patients with clinically important chronic infection or a history of recurrent infection. 3
1Smith CH, Yiu ZZN, Bale T, et al; British Association of Dermatologists’ Clinical Standards Unit. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: a rapid update. Br J Dermatol. 2020;183(4):628-637. https://doi.org/10.1111/bjd.19039
2Bakkour 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
3Taltz [summary of product characteristics]. Eli Lilly and Company (Ireland) Limited, Ireland
4Goodman SM, Springer B, Chen A, et al. 2022 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 Rheumatol. Published online June 20, 2022. https://doi.org/10.1002/art.42140
5Data on file, Eli Lilly and Company and/or one of its subsidiaries.
Date of Last Review: 21 June 2022