Ixekizumab for Treating Moderate-to-Severe Plaque Psoriasis II?

Ixekizumab for Treating Moderate-to-Severe Plaque Psoriasis?

Comment by InpharmD Researcher

The National Institute for Health and Care Excellence invited Eli Lilly and Company Ltd, the company manufacturing ixekizumab (tradename Taltz®), to submit evidence for the clinical and cost effectiveness of ixekizumab. Ixekizumab was compared with tumour necrosis factor-α inhibitors (etanercept, infliximab, adalimumab), ustekinumab, secukinumab, best supportive care and, if non-biological treatment or phototherapy is suitable, also compared with systemic non-biological therapies and phototherapy with ultraviolet B radiation for adults with moderate-to-severe plaque psoriasis. Kleijnen Systematic Reviews Ltd, in collaboration with Maastricht University Medical Center, was commissioned as the independent Evidence Review Group. This article presents a summary of the company submission, the Evidence Review Group report and the development of the National Institute for Health and Care Excellence guidance for the use of this drug in England and Wales by the Appraisal Committee. The Evidence Review Group produced a critical review of the clinical and cost effectiveness of ixekizumab based on the company submission. The company submission presented three randomised controlled trials identified in a systematic review. All randomised controlled trials were phase III, multicentre placebo-controlled trials including 3866 participants with moderate-to-severe psoriasis.

The company submission also included a network meta-analysis of relevant comparators. The Evidence Review Group highlighted some issues regarding the systematic review process and an issue with the generalisability of the findings in that the trials failed to include patients with moderate psoriasis according to a widely used definition. This issue was considered by the Appraisal Committee and the population was deemed generalisable to patients in England and Wales. Based on the network meta-analysis, the Appraisal Committee concluded that ixekizumab was more clinically effective than adalimumab and ustekinumab, and agreed it was likely that ixekizumab was similarly effective compared with secukinumab and infliximab while tolerability was similar to other biological treatments approved for treating psoriasis.

Background

Annual publications, countries, institutions, authors, journals, keywords, and references were visualized and analyzed using CiteSpace 5.8. R3 and VOSviewer1.6.18. This study included 1071 publications. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.

Since the beginning of 2011, the overall number of articles shows an upward trend. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. The most productive country and institution are the United States and the University of California system, respectively.

The most frequently cited author is Kang Dae-Wook, with 790 citations, who has contributed significantly to this field. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. Timothy Dinan is the most prolific author, with 34 articles.

The journal with the most published articles on this topic is Nutrients, whereas PLOS One is the most cited journal. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. The most used keyword is "gut microbiota," and the reference for the highest outbreak intensity is Hsiao.

Relevant Prescribing Information

Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.

Literature Review

A search of the published medical literature revealed 1 study investigating the researchable question:

Ixekizumab for Treating Moderate-to-Severe Plaque Psoriasis?

Level of evidence

B - One high-quality study or multiple studies with limitations Read more→

Please see Table 1 for your response.

Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
Design	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
Objective	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
Study Groups	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
Inclusion Criteria	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
Exclusion Criteria	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
Methods	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
Duration	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
Outcome Measures	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
Baseline Characteristics		A	B
	Age, years
	Female
	White
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	Include Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent. baseline characteristics that will provide a general (big picture) view of the patients in the study.
Results	Endpoint	A	B	p-Value
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	All results listed should correlate directly/exactly with the outcome measures presented previously.Results that do not have to do with the inquiry should not be included; just the stated outcomes need corresponding results. Tables are encouraged to display the most info using the least space/words.
Adverse Events	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
	Cholestyramine, an anion-exchange resin, acts by binding bile acids within the intestinal lumen, thus interfering with their reabsorption and enhancing their' fecal excretion. As a result, bile acid synthesis is markedly stimulated. This leads to an increased requirement for cholesterol in the liver, which causes an elevation of hepatic HMG-CoA reductase activity. Cholestyramine is highly effective in the treatment of many patients withhigh cholesterol levels, but unfortunately, it is not tolerated by all patients. Therefore, in spite of its proven usefulness, the bile acid sequestrant is not an idealcholesterol-lowering agent.
Study Author Conclusions	Copy and paste the author’s conclusions on the question at hand, using full sentences. Don’t include any conclusions that don’t correspond to results we list.
InpharmD Researcher Critique	As the expert, add 1-2 sentences on strengths, weaknesses, and takeaways from this study. Focus on insight as “more research is needed” is obvious.