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Axial spondyloarthritis (axSpA) is an umbrella term that includes ankylosing spondylitis and nonradiographic axSpA. Presence or absence of definitive sacroiliitis on radiographs differentiates ankylosing spondylitis (also called radiographic axSpA) from nonradiographic axSpA. There is growing evidence that indicates IL-17 pathway is a key contributor to the pathogenesis of axSpA. Ixekizumab (IXE) is an IL-17A inhibitor (IL-17i) with data to support its use in patients with radiographic axSpA. The pharmacologic properties of IXE were reviewed. Data regarding the use and efficacy of IXE in patients with radiographic axSpA were evaluated. Quality life outcomes and safety profiles of IXE were examined as well. By comparison with other chronic inflammatory arthritides, the number of targeted treatment options for axSpA is currently limited to tumor necrosis factor inhibitor (TNFi) and IL-17i secukinumab. IXE has good evidence of improved outcomes in terms of clinical efficacy, patient reported outcomes and imaging outcomes, with an acceptable safety profile in patients with radiographic axSpA. The current results discussed in this article support use of IXE as a treatment option for TNFi naive as well as in subjects with prior inadequate response to or intolerance to TNFi agents.

While there are several biologics with evidence for improved outcomes in AS, there is less evidence for biologic medications that have good efficacy in nr-axSpA. CZP has good evidence of improved outcomes in terms of clinical efficacy, patient reported outcomes and imaging outcomes in both conditions, with a tolerable safety profile.