What are treatment options for spondyloarthritis if Taltz (ixekizumab) has been discontinued by insurance?

From the Guidelines

If your insurance has discontinued coverage for Taltz (ixekizumab) to treat spondyloarthritis, the most effective alternative treatment option is to switch to another biologic medication, such as Humira (adalimumab) or Cosentyx (secukinumab), which target TNF-alpha or IL-17 pathways to reduce inflammation, as recommended by the 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 1.

Alternative Treatment Options

• Biologic medications: Humira (adalimumab), Enbrel (etanercept), Cimzia (certolizumab pegol), Simponi (golimumab), or Cosentyx (secukinumab) can be used to target TNF-alpha or IL-17 pathways and reduce inflammation.
• Non-biologic DMARDs: methotrexate (starting at 7.5-15mg weekly) or sulfasalazine (1-3g daily) may help peripheral joint symptoms.
• NSAIDs: naproxen (500mg twice daily) or celecoxib (200mg daily) can manage pain and inflammation as first-line therapy.

Non-Pharmacological Approaches

• Physical therapy and exercise programs can help improve symptoms and quality of life.
• Lifestyle modifications, such as maintaining good posture and quitting smoking, are also important.

Considerations

• Before switching treatments, contact your insurance company about possible appeals or patient assistance programs for Taltz, or discuss with your rheumatologist about which alternative would be most appropriate based on your specific type of spondyloarthritis, symptom severity, and medical history.
• The 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis also emphasizes the importance of individualized treatment and monitoring of disease activity 1.
• The 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations provides guidance on the use of biologic medications and other treatment options for ankylosing spondylitis and nonradiographic axial spondyloarthritis 1.

From the FDA Drug Label

Starting Week 16, dosage adjustment or addition of concomitant NSAIDs and DMARDs was permitted. Starting at Week 20, patients were allowed to switch to open-label 150 mg of subcutaneous COSENTYX monthly or other biologic at the discretion of the investigator and patient.

If Taltz has been discontinued by insurance, alternative treatment options for spondyloarthritis may include:

• NSAIDs: to help manage symptoms
• DMARDs: to help slow disease progression
• Other biologics: such as secukinumab (COSENTYX), which has been shown to be effective in treating spondyloarthritis 2 It is essential to consult a healthcare professional to determine the best course of treatment.

From the Research

Treatment Options for Spondyloarthritis

If Taltz has been discontinued by insurance, there are alternative treatment options available for spondyloarthritis. Some of these options include:

• Secukinumab (Cosentyx®), a fully human monoclonal antibody against interleukin-17A, which has been shown to be effective in treating ankylosing spondylitis (AS) and radiographic axial spondyloarthritis (r-axSpA) 3, 4, 5, 6
• Ixekizumab, another interleukin-17 antagonist, which has been compared to secukinumab in terms of efficacy and safety in active AS patients 5
• Tumor necrosis factor-α inhibitors, such as infliximab and adalimumab, which have been used to treat uveitis associated with spondyloarthritis 7
• Other biologics, such as certolizumab pegol, golimumab, and ustekinumab, which may be considered as alternative treatment options 7

Efficacy and Safety of Alternative Treatments

The efficacy and safety of these alternative treatments have been evaluated in several studies. For example:

• Secukinumab has been shown to significantly improve clinical signs and symptoms of AS and r-axSpA, and to be generally well tolerated with a low frequency of adverse events 3, 4, 6
• Ixekizumab has been compared to secukinumab and adalimumab in terms of efficacy and safety, and has been found to be effective in treating active AS without an increased risk of serious adverse events 5
• Tumor necrosis factor-α inhibitors have been used to treat uveitis associated with spondyloarthritis, with profound success reported for infliximab and adalimumab 7

Considerations for Treatment Selection

When selecting a treatment option, several factors should be considered, including:

• The patient's specific condition and disease activity
• The patient's medical history and comorbidities
• The potential benefits and risks of each treatment option
• The patient's preferences and values
• The availability and cost of each treatment option 6