Ixekizumab for treating active ankylosing spondylitis and non-radiographic axial spondyloarthritis

Ixekizumab is recommended as an option for treating active ankylosing spondylitis that is not controlled well enough with conventional treatments, or active non-radiographic axial spondyloarthritis with objective signs of inflammation (shown by elevated C-reactive protein or MRI) that is not controlled well enough with non-steroidal anti-inflammatory drugs (NSAIDs), in adults. It is recommended only if:

• the conditions have a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score of 4 units or more and a spinal visual analogue scale (VAS) of 4 cm or more

• tumour necrosis factor (TNF)-alpha inhibitors are not suitable or have not controlled the conditions well enough, and

• the company provides ixekizumab according to the commercial arrangement.

Assess response to ixekizumab after 16 to 20 weeks of treatment. Continue treatment only if there is clear evidence of response, defined as:

• a reduction in the BASDAI score to 50% of the pre-treatment value or by 2 or more units and

• a reduction in the spinal pain VAS by 2 cm or more.

Take into account any communication difficulties, or physical, psychological, sensory or learning disabilities that could affect responses to the BASDAI and spinal pain VAS questionnaires, and make any appropriate adjustments.

These recommendations are not intended to affect treatment with ixekizumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.