Taltz ® (ixekizumab) injection

80 mg/mL

This information is provided in response to your request. Resources may contain information about doses, uses, formulations and populations different from product labeling. See Prescribing Information above, if applicable.

How do you switch to Taltz® (ixekizumab) from a different biologic for psoriasis?

Specific recommendations on switching from another biologic therapy to ixekizumab are not available. Washout periods were required in clinical trials.

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Treatment Guidelines on Biologic Switching

The Joint American Academy of Dermatology and National Psoriasis Foundation 2019 guidelines on the treatment and management of psoriasis with biologics state that no evidence-based studies have been conducted to determine the appropriate duration of time between discontinuation of the previous medication and initiation of a biologic. The guidelines suggest assessments should be done on a case-by-case basis considering many factors that include

  • treatment being discontinued
  • disease severity
  • response to previous treatment, and
  • expert opinion; some experts will begin administration of the new biologic as soon as it is available; whereas, others may wait 3 to 4 half-lives of the previous therapy before beginning the new biologic.1

The British Association of Dermatologists 2020 psoriasis guidelines for biologic therapies include to consider using a washout period of 1 month or the length of a treatment cycle (whichever is longer) when transitioning between biologic therapies.2

The Transitioning Therapies program consensus published in 2014 recommends to include the use of a washout period if the switch is made due to an adverse event and do not include a washout period if the switch is made due to a lack of efficacy when switching from one biologic therapy to another. Initiation of the second biologic therapy occurs with the usual induction and maintenance dosages.3

Washout Period Requirements in the UNCOVER Clinical Trials

There are no specific recommendations on switching from another biologic therapy to ixekizumab for the treatment of psoriasis. 

In the pivotal ixekizumab phase 3 UNCOVER clinical trials, patients who were using biologic therapy discontinued biologic treatment prior to the baseline visit and prior to initiating ixekizumab therapy. Required Washout Periods for Patients Who Switched From Another Biologic Therapy to Ixekizumab in UNCOVER-1, -2, and -3 Clinical Trials lists the required washout periods, which ranged from at least 3 to 6 times the half-life of the product.4

Required Washout Periods for Patients Who Switched From Another Biologic Therapy to Ixekizumab in UNCOVER-1, -2, and -3 Clinical Trials4

Biologic

Washout Period

Infliximab

Minimum of 60 days

Adalimumab

Minimum of 60 days

Alefacept

Minimum of 60 days

Golimumab

Minimum of 90 days

Ustekinumab

Minimum of 8 months

Rituximab

Minimum of 12 months

Efalizumab

Minimum of 12 months

Other biologic agent

Minimum of 5 half-lives

Efficacy in Patients Who Switched From a Different Biologic

Of all subjects in the 3 pivotal ixekizumab UNCOVER clinical trials, 26% had received prior biologic therapy for the treatment of psoriasis.5

PASI 75 Response at Week 12 in Biologic-Experienced Patients in UNCOVER-1, -2, and -3 Clinical Trials provides 75% improvement from baseline in Psoriasis Area and Severity Index (PASI 75) response rate for patients who switched from a different biologic therapy to ixekizumab in the UNCOVER clinical trials. Examination of previous treatment with a biologic did not identify differences in response to ixekizumab among this subgroup at week 12.5

PASI 75 Response at Week 12 in Biologic-Experienced Patients in UNCOVER-1, -2, and -3 Clinical Trials4,6

UNCOVER-1

UNCOVER-2

UNCOVER-3

Treatment arm

n

Response Ratea

n

Response Ratea

n

Response Ratea

Ixekizumab Q2W

173

87.9

84

92.9

58

89.7

Ixekizumab Q4W

168

78.6

85

74.1

58

79.3

Etanercept

N/A

N/A

76

30.3

60

40.0

Placebo

181

3.3

43

0

33

3.0

Abbreviations: N/A = not applicable; PASI 75 = 75% improvement from baseline in Psoriasis Area and Severity Index; Q2W = every 2 weeks; Q4W = every 4 weeks.

aPercentage of patients who switched from another biologic therapy and achieved a PASI 75.

Additional Information

Package inserts for the respective products suggest caution with concomitant use of biologics. Given the small number of biologic switching studies, a washout period may be warranted if a patient switches from 1 biologic therapy to another.1,3,7 See respective package inserts for infliximab, adalimumab, alefacept, golimumab, ustekinumab, and rituximab.

References

The published references below are available by contacting 1-800-LillyRx (1-800-545-5979).

1Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029-1072. http://dx.doi.org/10.1016/j.jaad.2018.11.057

2Smith 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

3Mrowietz U, de Jong EMGJ, Kragballe K, et al. A consensus report on appropriate treatment optimization and transitioning in the management of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol. 2014;28(4):438-453. http://dx.doi.org/10.1111/jdv.12118

4Gordon KB, Blauvelt A, Papp KA, et al; UNCOVER-1, UNCOVER-2, and UNCOVER-3 Study Groups. Phase 3 trials of ixekizumab in moderate-to-severe plaque psoriasis. N Engl J Med. 2016;375(4):345-356. http://dx.doi.org/10.1056/NEJMoa1512711

5Taltz [package insert]. Indianapolis, IN: Eli Lilly and Company; 2021.

6Gerdes S, Korman N, Wilhelm S, et al. Efficacy of ixekizumab in patients with plaque psoriasis, with and without previous exposure to biologic therapies: results at Weeks 12 and 60 from UNCOVER-1. Poster presented at: 24th Congress of the European Academy of Dermatology and Venereology; October 7-15, 2015; Copenhagen, Denmark.

7Smith CH, Jabbar-Lopez ZK, Yiu ZZ, et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017. Br J Dermatol. 2017;177(3):628-636. http://dx.doi.org/10.1111/bjd.15665

Date of Last Review: February 11, 2022


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