Ixekizumab

• You must see your rheumatologist regularly to make sure the treatment is working and check for possible side effects.
• You should have regular blood tests as suggested by your rheumatologist.
• It is important to tell your rheumatologist if you have a new serious illness such as a serious infection, cancer, heart failure etc.
• Remember to change the injection site each time ixekizumab is injected.
• If you are worried about any side effects, you should contact your rheumatologist as soon as possible.
• You must tell your rheumatologist if you want to stop ixekizumab. If you don't, your treatment may no longer be funded.
• Let your rheumatologist know if you plan to become pregnant
• If you need a vaccination, tell your doctor you are being treated with ixekizumab before you have the vaccination. Some vaccines cannot be given while on ixekizumab.

You may notice joint swelling, pain and stiffness gets better within the first 8 weeks of starting ixekizumab.

Stopping ixekizumab

If you stop or delay your ixekizumab treatment, your condition might get worse. You should stay on the treatment unless your rheumatologist tells you to stop or if you get side effects (see Side effects).
If you stop ixekizumab for any reason, you must contact your rheumatologist. If you don’t, your treatment may stop being subsidised by Medicare.

How will you be checked while on ixekizumab?

Medicines like ixekizumab are very expensive but Medicare usually helps cover the cost if you meet certain conditions.

• Ixekizumab is only given if your disease is active and usual treatments have not worked.
• The treatment will continue only if it helps you, which is checked between 12 and 16 weeks after starting.
• You will need blood tests during treatment to check for side effects and see if it’s working.  
• How often you need blood tests depends on other medicines you take and any other illnesses you have. Your rheumatologist will tell you this.

Ixekizumab is injected just under the skin of the thigh or belly. It is best to avoid (if possible) any areas of skin affected by psoriasis. The prefilled autoinjector or syringe should be taken out of fridge 30 minutes before injecting so it can reach room temperature. Do not shake or freeze it. It can be injected by your doctor, nurse, carer, or by you. If injecting yourself, be sure to follow the detailed instructions carefully to ensure the best response. It is important to change the injection site each time.

If you miss an injection

Give the next injection as soon as you remember and continue to use it as you normally would. Do not inject a double dose to make up for a missed dose. If you have missed more than one dose or are not sure what to do, check with your doctor or pharmacist.

What is the dosage?

Ixekizumabcomes in a prefilled syringe or pen which has 80 mg of medicine. The usual starting dose is:

• For psoriatic arthritis - 2 injections, followed by 1 injection every 4 weeks. 
• For axial spondyloarthritis or non-radiographic axial spondyloarthritis – 1 injection every 4 weeks.

Can other arthritis medicines be taken with ixekizumab?

This medicine may be used alone or with other arthritis medicines including:

• Other Disease Modifying Anti Rheumatic Drugs (DMARDs) such as methotrexate.
• Steroid medicines such as prednisolone or cortisone injections into the joint.
• Anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn®) or ibuprofen (Brufen®, Nurofen®).
• Pain medicines such as paracetamol.

You might experience side effects with your treatment. Tell your doctor if you notice side effects that you think are caused by this medicine. Many side effects disappear when ixekizumab treatment is stopped.

Most common possible side effects

You may have more mild upper respiratory tract infections (common cold, sinus infections), nausea, diarrhoea, cough, and fever. Infections may need treatment and ixekizumab may need to be stopped for a while during an infection, so it is important to contact your doctor for advice.

Less common or rare possible side effects

There are some rare but sometimes serious side effects with ixekizumab, including:

• Thrush, athlete's foot and other fungal skin infections. Your doctor will do blood tests to monitor your white cells (which fight infection) which can rarely become low on ixekizumab.
• Rarely ixekizumab can cause an allergic reaction with itchy, red skin rash, chest tightness and trouble swallowing or breathing.
• Tell your doctor or go to the hospital immediately if you have an allergic reaction as you need urgent medical attention. 
• Flare ups of inflammatory bowel disease including Crohn’s disease or ulcerative colitis can occur while being treated with ixekizumab. If you have these conditions, your doctor should talk to you before starting this medicine, so you know the risks and to tell your doctor if you get tummy pain or diarrhoea. 

Infections

If you have an active infection, treatment with ixekizumab will not be started until the infection is treated. 

Before starting ixekizumab, your rheumatologist may screen you for some infections, including hepatitis B and C, HIV and tuberculosis. In most people this is done by asking you about possible past exposure to these infections and with a blood test, but some rheumatologists may choose to do a chest X-ray as well.

Use with other medicines

Ixekizumab can affect and be affected by other medicines. You should tell all your doctors about all medicines you are taking or plan to take. This includes over the counter or herbal/natural medicines.

Use with phototherapy (light therapy)

Ixekizumab should not be used while having light therapy (PUVA) for psoriasis.

Vaccines

• While being treated with ixekizumab you should have ‘live’ vaccines such as:
  MMR (measles, mumps and rubella), Varicella vaccines (Chicken pox/Shingles), OPV (oral polio virus), BCG (Bacillus Calmette Guerin), Japanese Encephalitis or Yellow Fever. Talk with your rheumatologist before receiving any vaccines.
• Pneumococcal vaccines and the yearly seasonal flu vaccinations are encouraged.
• For more information on vaccination including the COVID-19 vaccination go to: https://rheumatology.org.au/For-Patients/Medication-Information/Vaccinations/Vaccinations-in-Rheumatology

Surgery

If you need surgery for any reason, you should discuss this with your rheumatologist as some people might need to stop taking ixekizumab before surgery

Alcohol

You may drink alcohol while taking ixekizumab. However, if you are also taking methotrexate, you should be cautious about how much alcohol you drink.  

Pregnancy, breastfeeding and fertility

• We don’t know how ixekizumab can affect an unborn baby.
• If you are pregnant or thinking about having a child, you should discuss this with your rheumatologist before beginning this medicine. 
• Women who are able to be pregnant should use effective birth control (contraception) during treatment.
• If you have used ixekizumab during your pregnancy, you should check with your doctor before vaccinations are given to your baby. Some vaccines cannot be given to the newborn baby if you were treated with ixekizumab while you were pregnant.
• No studies have looked at ixekizumab in breastmilk, but it is unlikely to be harmful to a newborn baby. Women who are breastfeeding should talk to their doctor about whether or not to use ixekizumab.

• Store ixekizumab in the fridge, between 2 and 8°C
• Do not freeze. If needed, ixekizumab may be stored out of the fridge for a single period of up to 5 days at room temperature, not above 30°C. Do not return to the fridge once it has reached room temperature. Keep the syringes in the original carton to protect them from light until the time of use.
• Keep all medicines out of reach of children.

• After injecting ixekizumab, the used syringes should be placed in a puncture resistant container, like a sharps container. Dispose of your sharps container according to your state or local council regulations. If unsure how to dispose of your sharps container, ask your pharmacist.
• For more information, see the ‘Safe Disposal of Sharps’ guide.
• If your doctor tells you to stop using ixekizumab, or the expiry date has passed, ask your pharmacist what to do with the leftover medicine.