Ixekizumab and Breastfeeding

Summary of use during lactation

Little information is available on the clinical use of ixekizumab during breastfeeding. Because ixekizumab is a large protein molecule with a molecular weight of 146,000 Da, the amount in milk is likely to be very low.[1] It is also likely to be partially destroyed in the infant's gastrointestinal tract and absorption by the infant is probably minimal.[2] Some professional guidelines state that the drug is acceptable to use during breastfeeding.[3,4] Until more data become available, ixekizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. Waiting for at least 2 weeks postpartum to resume therapy may minimize transfer to the infant.[5]

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

A mother with generalized pustular psoriasis was treated with ixekizumab during lactation. No outcome data on the infant were presented.[6]

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

Alternative drugs to consider

(Psoriasis) Adalimumab, Certolizumab Pegol, Etanercept, Infliximab, Phototherapy, Tretinoin

References

1. Stratigakis A, Paty D, Zou P, et al. A regression approach for assessing large molecular drug concentration in breast milk. Reprod Breed 2023;3:199-207. doi:10.1016/j.repbre.2023.10.003
2. Anderson PO. Monoclonal antibodies during breastfeeding. Breastfeed Med 2021;16:591-3.33956488 PubMed
3. Smith CH, Yiu ZZN, Bale T, et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: A rapid update. Br J Dermatol 2020;183:628-37.32189327 PubMed
4. Russell MD, Dey M, Flint J, et al. British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: Immunomodulatory anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford) 2023;62:e48-e88.36318966 PubMed
5. Krysko KM, Dobson R, Alroughani R, et al. Family planning considerations in people with multiple sclerosis. Lancet Neurol 2023;22:350-66.36931808 PubMed
6. Huang D, Liu T, Li J, et al. Generalized pustular psoriasis recurring during pregnancy and lactation successfully treated with ixekizumab. Dermatol Ther 2022;35:e15878.36181408 PubMed