What are the risks of using Taltz (ixekizumab) in patients with pre-existing gallbladder conditions?

Taltz (Ixekizumab) and Gallbladder Conditions

There is no specific evidence indicating that Taltz (ixekizumab) increases the risk of gallbladder complications in patients with pre-existing gallbladder conditions, but caution is warranted as similar biologic agents have been associated with biliary issues.

Mechanism and Gallbladder Considerations

• Taltz (ixekizumab) is a humanized monoclonal immunoglobulin G antibody that specifically inhibits interleukin-17A (IL-17A), a pro-inflammatory cytokine involved in various inflammatory conditions 1
• Unlike GLP-1 receptor agonists which have established associations with gallbladder disease, there is no direct evidence in current guidelines linking Taltz to gallbladder complications 2, 3
• When considering biologics for patients with pre-existing gallbladder conditions, it's important to note that some biologics in different classes (particularly GLP-1 receptor agonists) have been associated with increased risk of gallbladder or biliary diseases 3, 4

Risk Assessment for Patients with Pre-existing Gallbladder Conditions

• Patients with pre-existing gallbladder disease should be monitored for potential biliary complications when using any biologic agent, including Taltz 2
• For patients with gallstones, the risk of complications increases with:
  • Multiple small gallstones (which can occur with some medications)
  • History of biliary colic or cholecystitis
  • Discontinuation of medications that affect gallbladder function 5

Comparison with Other Biologics

• GLP-1 receptor agonists have been clearly associated with increased risk of gallbladder disease (RR 1.37; 95% CI, 1.23-1.52), specifically cholelithiasis, cholecystitis, and biliary disease 3
• This risk is higher with:
  • Higher doses (RR 1.56; 95% CI, 1.36-1.78)
  • Longer duration of use (RR 1.40; 95% CI, 1.26-1.56)
  • When used for weight loss rather than diabetes management 3
• The 2024 AGA guidelines for ulcerative colitis note that S1P receptor modulators like ozanimod may cause cholelithiasis and gallstone-related complications, but do not mention similar concerns for IL-17 inhibitors like Taltz 2

Monitoring Recommendations

• For patients with pre-existing gallbladder conditions using Taltz:
  • Monitor for signs of biliary complications including right upper quadrant pain, jaundice, fever, or changes in liver function tests 2
  • Evaluate promptly for gallbladder disease if cholelithiasis or cholecystitis is suspected 2
  • Consider baseline liver function tests and periodic monitoring during treatment 2

Management Strategies

• If biliary complications develop while on Taltz:
  • Evaluate for gallbladder disease if cholelithiasis or cholecystitis is suspected 2
  • Consider temporary discontinuation of Taltz if acute cholecystitis or severe biliary complications occur 2
  • Manage biliary complications according to standard protocols, which may include antibiotics for cholangitis or cholecystitis, or surgical intervention when indicated 2
  • After resolution of acute biliary issues, reassess the risk-benefit ratio of continuing Taltz 2

Clinical Perspective

• When selecting biologics for patients with pre-existing gallbladder conditions, consider:
  • The lack of specific evidence linking Taltz to gallbladder complications compared to established risks with GLP-1 receptor agonists 3, 4
  • The patient's overall risk profile for biliary complications 2
  • Alternative treatment options if gallbladder disease is a significant concern 2

While there is no direct evidence that Taltz increases gallbladder complications, prudent clinical practice suggests monitoring patients with pre-existing gallbladder conditions for potential worsening of their condition during treatment.