Efficacy and safety of IL-17 inhibitors for the treatment of ankylosing spondylitis: a systematic review and meta-analysis

Abstract

Objectives: To systematically assess the efficacy and safety of IL-17 inhibitors in patients with active ankylosing spondylitis. Methods: A systematic review of the literature was performed for randomized controlled trials (RCTs) concerning IL-17 inhibitors in patients with ankylosing spondylitis. Meta-analyses were used to determine the efficacy and safety of the IL-17 inhibitors in the treatment of these patients. The primary end point was predefined as the proportion of patients with at least 20% improvement in the Assessment of Spondyloarthritis International Society (ASAS20) response criteria at week 16, and the secondary end point was defined as ASAS40 at week 16. Results: Six phase III randomized, double-blind, placebo-controlled trials including 1733 patients (1153 patients received IL-17 inhibitors, including secukinumab or ixekizumab, whereas 580 patients received a placebo as comparators) were included. At week 16, the IL-17 inhibitor regimen produced a significant increase in the ASAS20 response rate (RR=1.63, 95% CI 1.45 to 1.84, p=0.00) and the secondary endpoint ASAS40 response rate (RR=2.12, 95% CI 1.75 to 2.56, p=0.00) versus those for the placebo. With respect to the safety profile, more treatment-emergent adverse events (RR=1.11, 95% CI 1.01 to 1.22, p=0.03) and non-severe infections (RR=1.82, 95% CI 1.40 to 2.37, p<0.001) were described after treatment with IL-17 inhibitors than after treatment with placebo, while no increased risk of other adverse events was indicated after IL-17 inhibitor therapy, including death, discontinuation due to adverse events, or serious adverse events. Conclusions: IL-17 inhibitors produced favourable response rates but an increased risk of non-severe infections in the treatment of active ankylosing spondylitis.

Safety and Efficacy of Bimekizumab in Patients With Active Ankylosing Spondylitis: Three‐Year Results From a Phase IIb Randomized Controlled Trial and Its Open‐Label Extension Study

“…However, inhibition of IL‐17 is known to increase susceptibility to mucosal infections by Candida species, which reflects the role of type 17 immunity at the oral mucosa (41–44). Indeed, increased rates of infections and candidiasis have been associated with IL‐17A inhibitor treatment in patients with AS and other chronic inflammatory diseases (45,46). Here, we report data which indicate that Candida infections were among the most commonly reported TEAEs.…”

Tocilizumab, netakimab, and baricitinib in patients with mild-to-moderate COVID-19: a retrospective cohort study

“…However, our results indicate that tocilizumab or netakimab might be more effective in alleviating inflammation within the first 72 hours of therapy. Potential adverse events should probably be the key criteria for selecting immunosuppressive therapy for such patients, and considering the generally high safety profile of anti-IL-17 blockers 59 , those may represent the best option of the three for this category of patients. A prospective randomized trial will be necessary to verify our results, but we hope that our current observations will be useful in guiding therapy in individual cases based on the patient’s condition and potential risk of adverse events for each drug.…”

Bilobalide: A review of its pharmacology, pharmacokinetics, toxicity, and safety

“…(Guéry & Hugues, 2015). In recent years, both clinical results and experimental studies show that IL‐17 is closely related to the pathogenesis of ankylosing spondylitis (AS; Babaie et al, 2018; Dubash, Bridgewood, Mcgonagle, & Marzo‐Ortega, 2019; Wendling, Verhoeven, & Prati, 2019; Yin et al, 2020). Mao et al (2019) explored the effects of BB on AS inflammatory injury induced by IL‐17.…”