Good news for the approximately two million Americans with psoriatic arthritis (PsA). Those with active disease now have two new treatment options: the U.S. Food and Drug Administration (FDA) in December approved both ixekizumab (Taltz) and tofacitinib (Xeljanz) for the treatment of PsA.
This is the second approved indication for ixekizumab. The biologic, which is injected, was approved in March 2016 to treat moderate-to-severe plaque psoriasis in adults. It can be taken alone or in combination with a traditional disease-modifying antirheumatic drug (DMARD), such as methotrexate.
This is also the second approved indication for tofacitinib, a so-called targeted DMARD that is taken orally. Tofacitinib was first approved in 2012 to treat rheumatoid arthritis. It, too, can be taken alone or in combination with certain traditional DMARDs.
“It’s nice for patients to have options,” says M. Elaine Husni, MD, MPH, vice chair and director of the Arthritis Center at the Department of Immunologic and Rheumatic Diseases at Cleveland Clinic in Ohio. “People respond to drugs differently. What is wonderful is we get to be more personalized about our care. We don’t have to treat one-size-fits-all; we can be more tailored. So it’s important to have medications that work through different mechanisms.”
Ixekizumab inhibits interleukin-17A (IL-17A), a molecule involved in inflammatory and immune responses. It’s the second IL-17 inhibitor on the market for PsA. Additionally, there are other biologics approved to treat PsA that work through different mechanisms, including five tumor necrosis factor (TNF) inhibitors, and one that blocks IL-12 and IL-23. Tofacitinib is a JAK inhibitor; it works by blocking precise pathways inside immune cells.
Like other medications that interfere with the immune system, both ixekizumab and tofacitinib can increase the risk of infection. Before starting either one, patients need to be tested for tuberculosis. Additionally, ixekizumab could worsen symptoms of inflammatory bowel disease.
Author: Jennifer Davis for the Arthritis Foundation