Real-world drug survival and treatment outcome of ixekizumab in patients with spondyloarthropathies.

BACKGROUND: Chronic inflammatory rheumatic diseases, such as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and enteropathic arthritis, are collectively referred to as spondyloarthropathies (SpA). However, Real-world evidence on the effectiveness and safety of ixekizumab in spondyloarthropathies remains limited, particularly in diverse populations outside clinical trial settings. AIM: This study aimed to evaluate patient demographics, treatment outcomes, drug survival, and safety profile of ixekizumab in patients with SpA in a real-world clinical setting. METHODS: We conducted a retrospective cohort study at a tertiary care hospital in Riyadh, Saudi Arabia, from January 2018 to December 2024. Patients aged ≥14 years with SpA who received ixekizumab were included. The primary outcomes included drug survival, treatment discontinuation rates, and reasons for discontinuation. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to identify the predictors of treatment discontinuation. RESULTS: Among 93 patients (mean age 44.2 ± 13.2 years, 60.2% female), psoriatic arthritis spectrum disorders predominated (71.0%), followed by ankylosing spondylitis (23.7%). Most patients (87.1%) had prior biologic exposure, with ixekizumab used predominantly as a second-line therapy (59.1%). Drug survival rates were 69.9% at 12 months and 43.0% at 24 months, with a median survival of 23.0 months (95% CI: 19.5-26.5). The overall discontinuation rate was 34.4%, primarily due to lack of efficacy (59.4%) and adverse events (18.8%). Treatment-emergent adverse events occurred in 7.5% of patients, with no serious adverse events reported. Disease type significantly influenced drug survival (p = 0.018), with psoriatic arthritis showing superior retention compared with ankylosing spondylitis (77.8% vs. 60.0% at 12 months). Multivariate analysis identified third-line or later therapy (HR 2.58, 95% CI 1.04-6.40, p = 0.041) and the presence of treatment-emergent adverse events (HR 9.86, 95% CI 3.42-28.41, p < 0.001) as independent predictors of discontinuation. CONCLUSION: Ixekizumab demonstrated acceptable drug survival and safety profiles in real-world patients with spondyloarthritis, with differential effectiveness across disease subtypes. Earlier treatment initiation and proactive management of adverse events may optimize treatment outcomes, supporting personalized therapeutic approaches for spondyloarthropathy management.