Ixekizumab lowers SBP by 4.8 mmHg and DBP by 5.1 mmHg over 12 weeks in axial spondyloarthritis
Background
Axial spondyloarthritis (ax-SpA) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, often leading to significant pain and functional impairment. Patients with ax-SpA face an elevated risk of cardiovascular comorbidities, including hypertension, driven by systemic inflammation. Current treatments, while effective for managing disease activity, do not always directly address these associated cardiovascular risks. Targeting IL-17A, a key pro-inflammatory cytokine in ax-SpA pathogenesis, represents a promising strategy to potentially mitigate both inflammatory disease burden and its cardiovascular sequelae.
Study Design
This single-center, prospective, single-arm exploratory study enrolled 50 patients with axial spondyloarthritis (ax-SpA). Participants received the IL-17A inhibitor Ixekizumab with a 160 mg loading dose at week 0, followed by 80 mg every 4 weeks for 12 weeks. Researchers monitored disease activity using ASDAS-CRP, ASDAS-ESR, and BASDAI scores, along with inflammatory markers (CRP, ESR, IL-6), and blood pressure at baseline and every 4 weeks. A linear mixed-effects model was employed to analyze longitudinal changes in blood pressure.
Results
IL-17A inhibition with Ixekizumab significantly improved disease activity and reduced inflammatory marker levels (all p < 0.001). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) all exhibited time-dependent decreases throughout the study period.
Linear mixed-effects models estimated a reduction of 0.90 mmHg every 4 weeks for SBP (95% CI: -1.87 to 0.07, p = 0.071) and 0.91 mmHg per month for DBP (95% CI: -1.64 to -0.17, p = 0.016). After 12 weeks of treatment, SBP was decreased by 4.80 mmHg and DBP by 5.10 mmHg. Subgroup analysis revealed that the rate of DBP decline was more pronounced in patients with baseline hypertension (n=36). Furthermore, no obvious side effects were observed in hematological, hepatic, or renal function tests (both p < 0.01).
Key Findings
- Ixekizumab significantly improved ax-SpA disease activity and reduced inflammatory markers (all p < 0.001).
- Systolic blood pressure (SBP) decreased by 4.80 mmHg after 12 weeks of Ixekizumab treatment.
- Diastolic blood pressure (DBP) decreased by 5.10 mmHg after 12 weeks of Ixekizumab treatment.
- DBP reduction was more pronounced in patients with baseline hypertension (n=36).
- No significant adverse effects were observed in hematological, hepatic, or renal function tests (both p < 0.01).
Why It Matters
IL-17A inhibition with Ixekizumab could offer a dual benefit for ax-SpA patients, addressing both inflammatory disease activity and associated cardiovascular risk factors like hypertension. This suggests a potential for improved long-term health outcomes beyond just musculoskeletal symptom relief. For clinicians, these findings highlight the importance of monitoring blood pressure in ax-SpA patients on IL-17A inhibitors and considering these agents for those with comorbid hypertension, potentially leading to a more holistic treatment approach. While a definitive protocol requires further research, these results open avenues for optimizing therapy in high-risk populations and exploring the broader cardiovascular modulatory effects of IL-17A-targeted therapies.
ixekizumab
axial-spondyloarthritis
ax-spa
il-17a-inhibitor
blood-pressure
hypertension