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Meta-Analysis
. 2020 May 12;22(1):111.
doi: 10.1186/s13075-020-02208-w.

Efficacy and safety of IL-17 inhibitors for the treatment of ankylosing spondylitis: a systematic review and meta-analysis

Yufeng Yin  1 , Mingjun Wang  2 , Mengru Liu  3 , Erye Zhou  2 , Tian Ren  2 , Xin Chang  2 , Michun He  2 , Keqin Zeng  2 , Yufan Guo  2 , Jian Wu  2
Affiliations
Meta-Analysis

Efficacy and safety of IL-17 inhibitors for the treatment of ankylosing spondylitis: a systematic review and meta-analysis

Yufeng Yin et al. Arthritis Res Ther. .

Abstract

Objectives: To systematically assess the efficacy and safety of IL-17 inhibitors in patients with active ankylosing spondylitis.

Methods: A systematic review of the literature was performed for randomized controlled trials (RCTs) concerning IL-17 inhibitors in patients with ankylosing spondylitis. Meta-analyses were used to determine the efficacy and safety of the IL-17 inhibitors in the treatment of these patients. The primary endpoint was predefined as the proportion of patients with at least 20% improvement in the Assessment of Spondyloarthritis International Society (ASAS20) response criteria at week 16, and the secondary endpoint was defined as ASAS40 at week 16.

Results: Six phase III randomized, double-blind, placebo-controlled trials including 1733 patients (1153 patients received IL-17 inhibitors, including secukinumab or ixekizumab, whereas 580 patients received a placebo as comparators) were included. At week 16, the IL-17 inhibitor regimen produced a significant increase in the ASAS20 response rate (RR = 1.63, 95% CI 1.45 to 1.84, p = 0.00) and the secondary endpoint ASAS40 response rate (RR = 2.12, 95% CI 1.75 to 2.56, p = 0.00) versus those for the placebo. With respect to the safety profile, more treatment-emergent adverse events (RR = 1.11, 95% CI 1.01 to 1.22, p = 0.03) and non-severe infections (RR = 1.82, 95% CI 1.40 to 2.37, p < 0.001) were described after treatment with IL-17 inhibitors than after treatment with placebo, while no increased risk of other adverse events was indicated after IL-17 inhibitor therapy, including death, discontinuation due to adverse events, or serious adverse events.

Conclusions: IL-17 inhibitors produced favorable response rates but an increased risk of non-severe infections in the treatment of active ankylosing spondylitis.

Keywords: Ankylosing spondylitis; Efficacy; Interleukin inhibitors; Meta-analysis; Safety.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the search
Fig. 2
Fig. 2
Forest plot of the efficacy of IL-17 inhibitors in the treatment of patients with ankylosing spondylitis, using ASAS20 (a) and ASAS40 (b). ASAS20/40, Assessment of Spondyloarthritis International Society response criteria for improvement of 20%/40%; RR, risk ratio
Fig. 3
Fig. 3
Forest plot of the safety profile of IL-17 inhibitors in the treatment of patients with ankylosing spondylitis in terms of treatment-emergent adverse events (a), death (b), discontinuation due to adverse event (c), non-severe infections (d), or serious adverse events (e). RR, risk ratio
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