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Psoriatic Arthritis Efficacy

ACR results

Powerful joint symptom results in both biologic-naive and TNFi-experienced patients1-3

ACR RESPONSE RATES AT WEEK 24, NRI

Trial design


SELECT IMPORTANT SAFETY INFORMATION
INFECTIONS
Taltz may increase the risk of infection. In clinical trials of adult patients with plaque psoriasis, the Taltz group had a higher rate of infections than the placebo group (27% vs 23%). A similar increase in risk of infection was seen in placebo-controlled trials of adult patients with psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and pediatric patients with plaque psoriasis. Serious infections have occurred. Instruct patients to seek medical advice if signs or symptoms of clinically important chronic or acute infection occur. If a serious infection develops, discontinue Taltz until the infection resolves.

Taltz maintained response in joint symptoms through year 34

SPIRIT-P1 BIOLOGIC-NAIVE: ACR RESPONSE RATES DURING DOUBLE-BLIND AND OPEN-LABEL EXTENSION PERIODS, OBSERVED

In a modified nonresponder imputation (mNRI) analysis of patients receiving Taltz, ACR20 results were 76% at week 52, 70% at week 108, and 70% at week 156. ACR50 results were 60% at week 52, 52% at week 108, and 52% at week 156. ACR70 results were 40% at week 52, 30% at week 108, and 33% at week 156.

mNRI, a preferred method for analyzing long-term efficacy, imputes missing data due to study drug (eg, inadequate response, adverse event, or lack of efficacy) as nonresponse; whereas missing data due to other reasons (eg, missed visits, lost to follow-up) is included as a predicted value based on statistical modeling of observed data.

After week 24, patients knew they were taking active treatment, but remained blind to the dose until the last patient completed week 24. The uncontrolled extension period of the study has limitations (eg, no placebo comparisons, patients remaining in the study may be those with better results).

Trial design


SELECT IMPORTANT SAFETY INFORMATION
PRE-TREATMENT—EVALUATION FOR TUBERCULOSIS
Evaluate patients for tuberculosis (TB) infection prior to initiating treatment with Taltz. Do not administer to patients with active TB infection. Initiate treatment of latent TB prior to administering Taltz. Closely monitor patients receiving Taltz for signs and symptoms of active TB during and after treatment.

Powerful joint symptom improvement through week 521,2,5,6

SPIRIT-P2 TNFi-EXPERIENCED: ACR RESPONSE RATES DURING DOUBLE-BLIND AND OPEN-LABEL EXTENSION PERIODS, NRI

Primary endpoint=ACR20 response at week 24.

Inadequate responders (<20% improvement in tender and in swollen joint counts) at week 16 were analyzed as nonresponders after week 16 until the primary endpoint.

Patients and site personnel were blinded to study treatment until all patients completed week 24 or discontinued. The open-label phase of the study has limitations (eg, no placebo comparison, patients remaining in the extension phase may be those with better results).

Trial design


SELECT IMPORTANT SAFETY INFORMATION
HYPERSENSITIVITY
Serious hypersensitivity reactions, including angioedema and urticaria (each ≤0.1%), occurred in the Taltz group in clinical trials. Anaphylaxis, including cases leading to hospitalization, has been reported in post-marketing use with Taltz. If a serious hypersensitivity reaction occurs, discontinue Taltz immediately and initiate appropriate therapy.

Radiographic response

Taltz helped stop the progression of structural joint damage at week 16 vs placebo1-3,7

SPIRIT-P1 BIOLOGIC-NAIVE: ADJUSTED MEAN CHANGE FROM BASELINE IN mTSS, JOINT SPACE NARROWING SCORE, AND BONE EROSION SCORE AT WEEK 16, MMRM

Primary endpoint=ACR20 response at week 24.

Inhibition of progression of structural damage was assessed radiographically and expressed as the mean change in mTSS and its components, the joint space narrowing score and bone erosion score, at week 16 vs baseline. The mTSS score was modified for psoriatic arthritis by addition of hand distal interphalangeal (DIP) joints.

SPIRIT-P2 (TNFi-experienced) did not include an assessment of radiographic progression.

mTSS=modified Total Sharp Score; MMRM=mixed-effect model of repeated measure.

Trial design


SELECT IMPORTANT SAFETY INFORMATION
INFLAMMATORY BOWEL DISEASE
Patients treated with Taltz may be at an increased risk of inflammatory bowel disease. In clinical trials, Crohn’s disease and ulcerative colitis, including exacerbations, occurred at a greater frequency in the Taltz group than the placebo group. During Taltz treatment, monitor patients for onset or exacerbation of inflammatory bowel disease and if IBD occurs, discontinue Taltz and initiate appropriate medical management.

89% of Taltz patients had almost no progression of structural joint damage* at week 528,9

SPIRIT-P1 BIOLOGIC-NAIVE: POST HOC ANALYSIS OF OPEN-LABEL EXTENSION PERIOD POPULATION: CHANGE FROM BASELINE IN mTSS IN INDIVIDUAL PATIENTS AT WEEK 52, OBSERVED; 89% of Taltz patients had almost no progression of structural joint damage at week 52

Mean change from baseline in mTSS at week 52 was 0.47 for patients in the extension period on Taltz 80 mg every 4 weeks.

Trial design


SELECT IMPORTANT SAFETY INFORMATION
IMMUNIZATIONS
Prior to initiating Taltz, consider completion of all ageappropriate immunizations according to current immunization guidelines. Avoid use of live vaccines in patients treated with Taltz.

Dactylitis

Taltz showed improvement in patients with preexisting dactylitis2,3,10

SPIRIT-P1 BIOLOGIC-NAIVE: POST HOC ANALYSIS: COMPLETE RESOLUTION OF DACTYLITIS (LDI-B=0) AT WEEK 24 AMONG PATIENTS WITH LDI-B>0 AT BASELINE, NRI

Mean baseline LDI-B was 73.0 for Taltz and 62.7 for placebo.

In SPIRIT-P2 (TNFi-experienced) (Taltz 80 mg every 4 weeks n=28, mean baseline=31.5; placebo n=14, mean baseline=37.3), 75% of Taltz patients had complete resolution of dactylitis at week 24 vs 21% for placebo.

The data presented were from post hoc analyses and were not type-I error-controlled; therefore, treatment differences between Taltz and placebo cannot be regarded as statistically significant.

Inadequate responders (<20% in tender and in swollen join counts) at week 16 were analyzed as nonresponders after week 16 until the primary endpoint.

LDI-B=Leads Dactylitis Index-Basic.

Trial design


SELECT IMPORTANT SAFETY INFORMATION
ADVERSE REACTIONS
Most common adverse reactions (≥1%) associated with Taltz treatment are injection site reactions, upper respiratory tract infections, nausea, and tinea infections. Overall, the safety profiles observed in adult patients with psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and pediatric patients with plaque psoriasis were consistent with the safety profile in adult patients with plaque psoriasis, with the exception of influenza and conjunctivitis in psoriatic arthritis, and conjunctivitis, influenza, and urticaria in pediatric psoriasis.

FOR BIOLOGIC-NAIVE PATIENTS WITH PSORIATIC ARTHRITIS

Post hoc analysis: resolution of dactylitis (LDI-B=0) through week 1083,11

Double-blind and open-label extension periods, ITT population, mNRI and observed
Patients with dactylitis (LDI-B>0) at baseline
Mean baseline score-73

SPIRIT-P1 BIOLOGIC-NAIVE: RESOLUTION OF DACTYLITIS (LDI-B=0) THROUGH WEEK 108, OBSERVED

Primary endpoint=ACR20 response at week 24.

mNRI, a preferred method for analyzing long term efficacy, imputes missing data due to study drug (e.g., inadequate response, adverse event, or lack of efficacy), as nonresponse; whereas, missing data due to other reasons (e.g., missed visits, lost to follow-up) is included as a predicted value based on statistical modeling of observed data.

Inadequate responders (<20% improvement in tender and in swollen joint counts) at week 16 were analyzed as nonresponders after week 16 until the primary endpoint.

After week 24, patients knew they were taking active treatment, but remained blind to the dose until the last patient completed week 24. The uncontrolled extension period of the study has limitations (e.g., no placebo comparisons, patients remaining in the study may be those with better results).

LDI-B=Leeds Dactylitis Index-Basic.

mNRI=modified nonresponder imputation.

Trial design


SELECT IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
Taltz is contraindicated in patients with a previous serious hypersensitivity reaction, such as anaphylaxis, to ixekizumab or to any of the excipients.

Enthesitis

Taltz showed improvement in patients with preexisting enthesitis2,3,10,12

SPIRIT-P1 BIOLOGIC-NAIVE: POST HOC ANALYSIS: COMPLETE RESOLUTION OF ENTHESITIS (LEI=0) AT WEEK 24 AMONG PATIENTS WITH LEI>0 AT BASELINE, NRI

Mean baseline LEI was 2.8 for Taltz and 2.9 for placebo.

In SPIRIT-P2 (TNFi-experienced) in patients with LEI >0 (Taltz 80 mg every 4 weeks n=68, mean baseline=2.9; placebo n=69, mean baseline=2.9), LEI=0 at week 24, a prespecified, error-controlled endpoint, was not statistically significant vs placebo. At week 24, 35% of Taltz patients had LEI=0 vs 22% for placebo.

The data presented from SPIRIT-P1 were from post hoc analyses and were not type-I error-controlled; therefore, treatment differences between Taltz and placebo cannot be regarded as statistically significant. In addition, the mean change from baseline in LEI score at week 12 (prespecified endpoint in SPIRIT-P1) was error-controlled, but was not statistically significant compared to placebo.

Inadequate responders (<20% in tender and in swollen join counts) at week 16 were analyzed as nonresponders after week 16 until the primary endpoint.

LEI=Leeds Enthesitis Index.

Trial design


SELECT IMPORTANT SAFETY INFORMATION
INFECTIONS
Taltz may increase the risk of infection. In clinical trials of adult patients with plaque psoriasis, the Taltz group had a higher rate of infections than the placebo group (27% vs 23%). A similar increase in risk of infection was seen in placebo-controlled trials of adult patients with psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and pediatric patients with plaque psoriasis. Serious infections have occurred. Instruct patients to seek medical advice if signs or symptoms of clinically important chronic or acute infection occur. If a serious infection develops, discontinue Taltz until the infection resolves.

Post hoc analysis: resolution of enthesitis (LEI=0) through week 10812,13

Double-blind and open-label extension periods, ITT population, observed and mNRI
Patients with Enthesitis (LEI Score>0) at Baseline
Mean baseline score=2.8

SPIRIT-P1 BIOLOGIC-NAIVE:RESOLUTION OF ENTHESITIS (LEI=0) THROUGH WEEK 108, OBSERVED

Primary endpoint=ACR20 response at week 24.

In a modified nonresponder imputation (mNRI) analysis of patients receiving Taltz, 57% of patients achieved LEI=0 at week 52 and 55% at week 108.

mNRI, a preferred method for analyzing long term efficacy, imputes missing data due to study drug (e.g., inadequate response, adverse event, or lack of efficacy), as nonresponse; whereas, missing data due to other reasons (e.g., missed visits, lost to follow-up) is included as a predicted value based on statistical modeling of observed data.

Primary endpoint=ACR20 response at week 24.

Inadequate responders (<20% improvement in tender and in swollen joint counts) at week 16 were analyzed as nonresponders after week 16 until the primary endpoint.

After week 24, patients knew they were taking active treatment, but remained blind to the dose until the last patient completed week 24. The uncontrolled extension period of the study has limitations (e.g., no placebo comparisons, patients remaining in the study may be those with better results).

LEI=Leeds Enthesitis Index.

mNRI=modified nonresponder imputation.

Trial design


SELECT IMPORTANT SAFETY INFORMATION
PRE-TREATMENT—EVALUATION FOR TUBERCULOSIS
Evaluate patients for tuberculosis (TB) infection prior to initiating treatment with Taltz. Do not administer to patients with active TB infection. Initiate treatment of latent TB prior to administering Taltz. Closely monitor patients receiving Taltz for signs and symptoms of active TB during and after treatment.

Concomitant MTX use

ACR20 response vs placebo with or without concomitant methotrexate1,14-15

SPIRIT-P1 BIOLOGIC-NAIVE: PATIENTS ACHIEVING ACR20 RESPONSE AT WEEK 24, NRI

ADDITIONAL WEEK 24 RESULTS FROM SPIRIT-P2 TRIAL

In SPIRIT-P2 (TNFi-experienced) (Taltz 80 mg every 4 weeks n=48; placebo n=40), 50% of Taltz patients achieved ACR20 with concomitant MTX at week 24 vs 18% for placebo. Additionally (Taltz n=74; placebo n=78), 55% of Taltz patients achieved ACR20 without MTX use at week 24 vs 21% for placebo. All patients in SPIRIT-P2 were previously treated with at least 1 cDMARD (methotrexate, sulfasalazine, leflunomide, or hydroxychloroquine)

All patients were allowed to remain on stable background therapy.

Nonresponder imputation (NRI) of intent-to-treat population through week 24.

Inadequate responders (<20% improvement in tender and in swollen joint counts) at week 16 were analyzed as nonresponders after week 16 until the primary endpoint.

No lab monitoring (including liver function tests) is required for treatment with Taltz as monotherapy.

During Taltz treatment, monitor patients for signs and symptoms of infection and for onset or exacerbation of inflammatory bowel disease. During and after treatment with Taltz, monitor patients for active tuberculosis (TB) infection.

The data presented were from post hoc analyses and were not type-1 error-controlled; therefore, treatment differences between Taltz and placebo cannot be regarded as statistically significant.

MTX=methotrexate.

Trial design


SELECT IMPORTANT SAFETY INFORMATION
HYPERSENSITIVITY
Serious hypersensitivity reactions, including angioedema and urticaria (each ≤0.1%), occurred in the Taltz group in clinical trials. Anaphylaxis, including cases leading to hospitalization, has been reported in post-marketing use with Taltz. If a serious hypersensitivity reaction occurs, discontinue Taltz immediately and initiate appropriate therapy.

Psoriatic Arthritis skin data

Treatment with Taltz resulted in an improvement in psoriatic skin lesions1-3,16

SPIRIT-P1 BIOLOGIC-NAIVE: PASI RESPONSE RATES AT WEEK 12 IN PsA PATIENTS WITH PLAQUE PSORIASIS ≥3% BSA, NRI

In SPIRIT-P1, among patients with sPGA ≥3 at baseline (Taltz 80 mg every 4 weeks n=52; placebo n=41), 75% of patients taking Taltz achieved sPGA 0,1 at week 12 vs 7% who received placebo. Additionally, 31% of patients receiving Taltz achieved sPGA 0 at week 12 vs 2% for placebo.


ADDITIONAL WEEK 12 RESULTS FROM SPIRIT-P2 TRIAL

In SPIRIT-P2 (TNFi-experienced, ≥3% BSA) (Taltz 80 mg every 4 weeks n=68, placebo n=67), 57% of patients receiving Taltz achieved PASI 75 at week 12 vs 10% for placebo. Additionally, 38% and 19% of patients receiving Taltz achieved PASI 90 and PASI 100, respectively, at week 12 vs 6% and 6% for placebo. Among patients with sPGA ≥3 at baseline (Taltz 80 mg every 4 weeks n=60, placebo n=55), 63% of patients taking Taltz achieved sPGA 0,1 at week 12 vs 4% of patients who received placebo. Additionally, 23% of patients receiving Taltz achieved sPGA 0 vs 2% for placebo.

Trial design


SELECT IMPORTANT SAFETY INFORMATION
INFLAMMATORY BOWEL DISEASE
Patients treated with Taltz may be at an increased risk of inflammatory bowel disease. In clinical trials, Crohn’s disease and ulcerative colitis, including exacerbations, occurred at a greater frequency in the Taltz group than the placebo group. During Taltz treatment, monitor patients for onset or exacerbation of inflammatory bowel disease and if IBD occurs, discontinue Taltz and initiate appropriate medical management.

Taltz maintained response in skin clearance through year 31,17

SPIRIT-P1 BIOLOGIC-NAIVE: PASI RESPONSE RATES DURING DOUBLE-BLIND AND UNCONTROLLED EXTENSION PERIODS, OBSERVED

In an mNRI analysis of patients receiving Taltz, PASI 75 results were 80% at week 52, 69% at week 108, and 64% at week 156. PASI 90 results were 67% at week 52, 61% at week 108, and 51% at week 156. PASI 100 results were 56% at week 52, 47% at week 108, and 44% at week 156.

mNRI analysis imputes missing data due to study drug (e.g., inadequate response, adverse event, or lack of efficacy) as nonresponse; whereas missing data due to other reasons (e.g., missed visits, lost to follow-up) is included as a predicted value based on statistical modeling of observed data.

Inadequate responders (<20% improvement in tender and in swollen joint counts) at week 16 were analyzed as nonresponders after week 16 until the primary endpoint.

After week 24, patients knew they were taking active treatment, but remained blind to the dose until the last patient completed week 24. The uncontrolled extension period of the study has limitations (e.g., no placebo comparisons, patients remaining in the study may be those with better results).

BSA=body surface area; mNRI=modified nonresponder imputation; PASI=Psoriasis Area and Severity Index.

Inadequate responders (<20% improvement in tender and in swollen joint counts) at week 16 were analyzed as nonresponders after week 16 until the primary endpoint.

Trial design


SELECT IMPORTANT SAFETY INFORMATION
IMMUNIZATIONS
Prior to initiating Taltz, consider completion of all ageappropriate immunizations according to current immunization guidelines. Avoid use of live vaccines in patients treated with Taltz.

References: 1. Taltz [package insert]. Indianapolis, IN: Eli Lilly and Company; 2020. 2. Nash P, Kirkham B, Okada M, et al; on behalf of SPIRIT-P2 Study Group. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet. 2017;389:2317-2327. 3. Mease PJ, van der Heijde D, Ritchlin CT, et al; on behalf of SPIRIT-P1 Study Group. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann Rheum Dis. 2017;76:79-87. 4. Data on file. Lilly USA, LLC. DOF-IX-US-0013. 5. Data on file. Lilly USA, LLC. DOF-IX-US-0015. 6. Genovese MC, Combe B, Kremer J, et al. Safety and efficacy of ixekizumab in patients with PsA and previous inadequate response to TNF inhibitors: week 52 results from SPIRIT-P2. Rheumatology. 2018. doi:10.1093/rheumatology/key182. 7. Data on file. Lilly USA, LLC. TAL20171026B. 8. Data on file. Lilly USA, LLC. DOF-IX-US-0017. 9. van der Heijde D, Gladman DD, Kishimoto M, et al. Efficacy and safety of ixekizumab in patients with active psoriatic arthritis: 52-week results from a phase III study (SPIRIT-P1). J Rheumatol. 2018;45:367-377. 10. Nash P, Kirkham B, Okada M, et al; on behalf of SPIRIT-P2 Study Group. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet. 2017;389:2317-2327. Supplementary appendix. 11. Data on file. Lilly USA, LLC. TAL04022018A. 12. Data on file. Lilly USA, LLC. TAL20171002A. 13. Data on file. Lilly USA, LLC. TAL04022018B. 14. Data on file. Lilly USA, LLC. TAL20170919A. 15. Data on file. Lilly USA, LLC. TAL20171026A. 16. Data on file. Lilly USA, LLC. TAL20171127A. 17. Data on file. Lilly USA, LLC. DOF-IX-US-0012.

Indications and Important Safety Information
Indications

Taltz is indicated for adults with active psoriatic arthritis (PsA), for adults with active ankylosing spondylitis (AS), and for adults with active non-radiographic axial spondyloarthritis (nr-axSpA) with objective signs of inflammation. Taltz is also indicated for patients aged 6 years or older with moderate-to-severe plaque psoriasis (PsO) who are candidates for systemic therapy or phototherapy.

Important Safety Information
CONTRAINDICATIONS
Taltz is contraindicated in patients with a previous serious hypersensitivity reaction, such as anaphylaxis, to ixekizumab or to any of the excipients.

WARNINGS AND PRECAUTIONS
Infections
Taltz may increase the risk of infection. In clinical trials of adult patients with plaque psoriasis, the Taltz group had a higher rate of infections than the placebo group (27% vs 23%). A similar increase in risk of infection was seen in placebo-controlled trials of adult patients with psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and pediatric patients with plaque psoriasis. Serious infections have occurred. Instruct patients to seek medical advice if signs or symptoms of clinically important chronic or acute infection occur. If a serious infection develops, discontinue Taltz until the infection resolves.

Pre-Treatment Evaluation for Tuberculosis
Evaluate patients for tuberculosis (TB) infection prior to initiating treatment with Taltz. Do not administer to patients with active TB infection. Initiate treatment of latent TB prior to administering Taltz. Closely monitor patients receiving Taltz for signs and symptoms of active TB during and after treatment.

Hypersensitivity
Serious hypersensitivity reactions, including angioedema and urticaria (each ≤0.1%), occurred in the Taltz group in clinical trials. Anaphylaxis, including cases leading to hospitalization, has been reported in post-marketing use with Taltz. If a serious hypersensitivity reaction occurs, discontinue Taltz immediately and initiate appropriate therapy.

Inflammatory Bowel Disease
Patients treated with Taltz may be at an increased risk of inflammatory bowel disease. In clinical trials, Crohn’s disease and ulcerative colitis, including exacerbations, occurred at a greater frequency in the Taltz group than the placebo group. During Taltz treatment, monitor patients for onset or exacerbations of inflammatory bowel disease and if IBD occurs, discontinue Taltz and initiate appropriate medical management.

Immunizations
Prior to initiating therapy with Taltz, consider completion of all age-appropriate immunizations according to current immunization guidelines. Avoid use of live vaccines in patients treated with Taltz.

ADVERSE REACTIONS
Most common adverse reactions (≥1%) associated with Taltz treatment are injection site reactions, upper respiratory tract infections, nausea, and tinea infections. Overall, the safety profiles observed in adult patients with psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and pediatric patients with plaque psoriasis were consistent with the safety profile in adult patients with plaque psoriasis, with the exception of influenza and conjunctivitis in psoriatic arthritis and conjunctivitis, influenza, and urticaria in pediatric psoriasis.

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IX HCP ISI 07MAY2020

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SPIRIT-H2H: Trial design9

Taltz icon

SPIRIT-H2H (N=566) was a phase 4, randomized, open-label, blinded-assessor study evaluating the efficacy and safety of Taltz vs Humira in biologic-naive patients with active psoriatic arthritis and plaque psoriasis BSA ≥3%.

Patients who met the trial design criteria for moderate to severe psoriasis (BSA ≥10%, PASI ≥12, and sPGA ≥3) in addition to psoriatic arthritis followed the psoriasis dosing regimen: Taltz patients (n=49) received an initial dose of 160 mg (two 80 mg injections), followed by 80 mg every 2 weeks through week 12, then 80 mg every 4 weeks thereafter. Humira patients (n=52) received an initial dose of 80 mg, then 40 mg every other week starting 1 week after the initial dose. For Taltz patients with psoriatic arthritis only (n=234), the initial dose (160 mg as 2 injections) was followed by 80 mg every 4 weeks. Humira patients (n=231) received 40 mg every other week and no initial dose.

SPIRIT-H2H: Trial design1

SPIRIT-H2H (N=566) was a phase 4, randomized, open-label, blinded-assessor study evaluating the efficacy and safety of Taltz vs Humira® (adalimumab) in biologic-naive patients with active psoriatic arthritis and plaque psoriasis BSA ≥3%. The primary efficacy endpoint was the proportion of patients simultaneously achieving ACR50 and PASI 100 at week 24. All patients were ≥18 years of age and had ≥3 swollen and ≥3 tender joints with an inadequate response to ≥1 cDMARD. Patients were randomized (1:1) to Taltz or Humira and allowed to continue a stable dose of concomitant cDMARD during the study. For Taltz patients with psoriatic arthritis only (n=234), the initial dose (160 mg as 2 injections) was followed by 80 mg every 4 weeks. Humira patients (n=231) received 40 mg every other week and no initial dose. Patients who met the trial design criteria for moderate to severe psoriasis (BSA ≥10%, PASI ≥12, and sPGA ≥3) in addition to psoriatic arthritis followed the psoriasis dosing regimen: Taltz patients (n=49) received an initial dose of 160 mg (two 80 mg injections), followed by 80 mg every 2 weeks through week 12, then 80 mg every 4 weeks thereafter. Humira patients (n=52) received an initial dose of 80 mg, then 40 mg every other week starting 1 week after the initial dose.

Reference:1. Data on file. Lilly USA, LLC. DOF-IX-US-0119.

BSA=body surface area; ACR50=American College of Rheumatology 50% response;
PASI=Psoriasis Area Severity Index; cDMARD=conventional disease-modifying antirheumatic drug; sPGA=static Physician's Global Assessment.

SPIRIT-P1 and -P2 Trial Design1-4

SPIRIT-P1 (N=417) and -P2 (N=363) were phase 3, randomized, double-blind, placebo-controlled trials to evaluate the efficacy and safety of Taltz compared with placebo in patients with active psoriatic arthritis. Patients in SPIRIT-P1 were biologic-naive. Patients in SPIRIT-P2 were tumor necrosis factor inhibitor (TNFi)-experienced, having had an inadequate response and/or intolerance to 1 or 2 prior TNFis. In both trials, the primary efficacy endpoint was the proportion of patients achieving ACR20 response at week 24. All patients were ≥18 years of age and had ≥3 swollen and ≥3 tender joints. Patients were randomized to placebo or Taltz 80 mg every 2 or 4 weeks following a 160 mg starting dose. In SPIRIT-P1, an active reference arm of Humira® (adalimumab) 40 mg every 2 weeks was included. Patients in all study arms were allowed to continue taking stable background medications during the trial. Inadequate responders (as defined by blinded criteria of <20% improvement in tender and in swollen joint counts) at week 16 received rescue therapy and were analyzed as nonresponders after week 16 until the primary endpoint. After receiving rescue therapy, inadequate responders in the placebo and Humira arms were re-randomized to Taltz 80 mg every 2 or 4 weeks. Nonresponder imputation (NRI) methods were used for categorical efficacy analyses during the double-blind treatment period.

Reference: 1. Taltz [package insert]. Indianapolis, IN: Eli Lilly and Company; 2020. 2. Mease PJ, van der Heijde D, Ritchlin CT, et al; on behalf of SPIRIT-P1 Study Group. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase 3 trial SPIRIT-P1. Ann Rheum Dis. 2017;76(suppl):1-30. 3. Nash P, Kirkham B, Okada M, et al; on behalf of SPIRIT-P2 Study Group. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet. 2017;389:2317-2327. 4. Nash P, Kirkham B, Okada M, et al; on behalf of SPIRIT-P2 Study Group. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet. 2017;389:2317-2327. Supplementary appendix.

ACR20=American College of Rheumatology 20% response.

SPIRIT-P1 and -P2: Trial design12-15

Registration Trials

SPIRIT-P1 (N=417) and SPIRIT-P2 (N=363) were phase 3, randomized, double-blind, placebo-controlled trials to evaluate the efficacy and safety of Taltz compared with placebo in patients with active psoriatic arthritis. Patients in SPIRIT-P1 were biologic-naive. Patients in SPIRIT-P2 were tumor necrosis factor inhibitor (TNFi)-experienced, having had an inadequate response and/or intolerance to 1 or 2 prior TNFis. In both trials, the primary efficacy endpoint was the proportion of patients achieving ACR20 response at week 24. All patients were ≥18 years of age and had ≥3 swollen and ≥3 tender joints. Patients were randomized to placebo or Taltz 80 mg every 2 or 4 weeks following a 160 mg starting dose. In SPIRIT-P1, an active reference arm of adalimumab 40 mg every 2 weeks was included. Patients in all study arms were allowed to continue taking stable background medications during the trial. Inadequate responders (as defined by blinded criteria of <20% improvement in tender and in swollen joint counts) at week 16 received rescue therapy and were analyzed as nonresponders after week 16 until the primary endpoint. After receiving rescue therapy, inadequate responders in the placebo and adalimumab arms were re-randomized to Taltz 80 mg every 2 or 4 weeks. Nonresponder imputation (NRI) methods were used for categorical efficacy analyses during the double-blind treatment period.

IXORA-PEDS TRIAL DESIGN

IXORA-PEDS (N=171) is an ongoing, multicenter, randomized, double-blind, placebo-controlled phase 3 study designed to evaluate the efficacy and safety of Taltz in pediatric patients aged 6 to <18 years with moderate to severe plaque psoriasis. All patients have a diagnosis of moderate to severe plaque psoriasis for at least 6 months, with a body surface area (BSA) of ≥10%, a static Physician’s Global Assessment (sPGA) score ≥3, and a Psoriasis Area Severity Index (PASI) score ≥12, and are candidates for systemic therapy or phototherapy. Patients were randomized to receive Taltz every 4 weeks (n=115), with dosing based on body weight, or placebo (n=56). Of patients receiving Taltz, those weighing <25 kg were randomized to Taltz 20 mg every 4 weeks following a 40 mg starting dose, those weighing 25 to 50 kg were randomized to Taltz 40 mg every 4 weeks following an 80 mg starting dose, and those weighing >50 kg were randomized to Taltz 80 mg following a starting dose of 160 mg. Co-primary efficacy endpoints were the percentage of patients achieving PASI 75 and sPGA 0,1 at week 12. Secondary endpoints were the percentage of patients achieving the following measures: PASI 75 at week 4, sPGA 0,1 at week 4, PASI 90 at week 12, PASI 100 at week 12, sPGA 0 at week 12, and Itch Numeric Rating Scale (I-NRS) ≥4-point improvement at week 12. Nonresponder imputation methods (NRI) were used for categorical efficacy analyses.

Following the double-blind treatment period, patients are allowed to transition to an open-label maintenance period (weeks 12-60) and extension period (weeks 60-108) where all patients, regardless of initial treatment, will receive Taltz every 4 weeks through week 108. Patients who were taking placebo were initiated to Taltz with the appropriate weight-based starting dose, followed by the appropriate weight-based Q4W dose.

References: 1.Data on file. Lilly USA, LLC. DOF-IX-US-0211.