This study aimed to evaluate the safety and efficacy of IL-17 inhibitors (comprising secukinumab or ixekizumab) in active ankylosing spondylitis patients.

The literature search for the systematic review included the randomized controlled trials (RCTs) with patients with ankylosing spondylitis who were given IL-17 inhibitors. Safety and efficacy of the IL-17 inhibitors therapy was determined in meta-analysis. The patients with minimum 20% improvement as per the Assessment of Spondyloarthritis International Society (ASAS20) response criteria at week 16 were regarded as the primary endpoint. The ASAS40 at week 16 was regarded as the secondary endpoint.

Six randomized, double-blind, placebo-controlled trials with 1733 patients were included. Out of these, 1153 patients were given IL-17 inhibitors, while 580 patients were given placebo. The IL-17 inhibitor treatment was found to significantly increase the ASAS20 response rate and secondary endpoint ASAS40 response rate (RR = 1.63, 95% CI 1.45 to 1.84 and RR = 2.12, 95% CI 1.75 to 2.56, respectively) as compared to placebo. As per safety outcomes, the number of treatment-related adverse events and non-severe infections were more (RR = 1.11, 95% CI 1.01 to 1.22 and RR = 1.82, 95% CI 1.40 to 2.37, respectively) following the IL-17 inhibitors therapy as compared to with placebo. There was no augmented risk of added adverse events after IL-17 inhibitor therapy.

Inspite of increased risk of non-severe infections in the active ankylosing spondylitis treatment, IL-17 inhibitors delivered promising response rates.