How Cosentyx and Taltz Work for Ankylosing Spondylitis
Cosentyx (secukinumab) is an IL-17A inhibitor that blocks a protein driving inflammation in ankylosing spondylitis (AS), a type of axial spondyloarthritis. Taltz (ixekizumab) also targets IL-17A but binds it more tightly, potentially affecting inflammation differently. Both are FDA-approved for active AS in adults, with Cosentyx approved in 2016 and Taltz in 2019.[1][2]
Key Efficacy Comparison from Clinical Trials
In head-to-head terms, no direct trials compare them, but pivotal studies show similar response rates. Cosentyx's MEASURE trials reported 61% of patients achieving ASAS40 (40% improvement in AS symptoms) at 16 weeks, versus 59% for Taltz in COAST-V (biologic-naive patients).[3][4] Both reduce MRI inflammation and BASDAI scores (disease activity) comparably over 2 years, with sustained remission in about 20-30% of patients. Cosentyx may edge out in spinal radiographic progression slowing based on 5-year data.[5]
| Metric (at 16 weeks) | Cosentyx | Taltz |
|----------------------|----------|-------|
| ASAS20 | 66% | 65% |
| ASAS40 | 61% | 59% |
| ASAS partial remission | 24% | 29% |
Data from phase 3 trials; real-world retention rates are high for both (70-80% at 1 year).[6]
Dosing and Administration Differences
Cosentyx starts with 150mg weekly subcutaneous injections for 5 doses, then monthly 150mg (or 300mg for some). Taltz uses 160mg initial dose, then 80mg every 4 weeks. Both are self-injected; Taltz's higher upfront dose may cause more initial injection-site reactions.[1][2]
Safety and Side Effects Patients Report
Common side effects overlap: upper respiratory infections (10-15%), diarrhea, and nasopharyngitis. Taltz shows slightly higher rates of inflammatory bowel disease flares (1-2% vs. <1% for Cosentyx), a concern in AS patients with gut involvement. Serious infections occur in 1-3% for both; IBD risk leads some rheumatologists to prefer Cosentyx in at-risk patients. Candida infections are more frequent with both (3-4%).[7][8]
Cost and Insurance Coverage
List prices are similar: ~$6,000-$7,000 per month before discounts. Patient copays average $0-50/month with coverage; both qualify for manufacturer assistance programs. Biosimilars are not yet available, but patents extend into the 2030s—no expiry details on DrugPatentWatch.com for these indications.[9]
Who Might Choose One Over the Other
Cosentyx suits patients prioritizing long-term radiographic data or IBD history. Taltz fits those needing faster partial remission or with psoriasis comorbidity (stronger skin data). Switch rates are low (10-15% at 1 year) due to comparable efficacy; guidelines list both as first-line biologics after NSAIDs/TNF inhibitors fail.[10]
[1]: FDA Label - Cosentyx (secukinumab)
[2]: FDA Label - Taltz (ixekizumab)
[3]: Baeten et al., Lancet 2015 (MEASURE 2)
[4]: Dougados et al., Lancet 2019 (COAST-V)
[5]: Baraliakos et al., Rheumatology 2021
[6]: Glintborg et al., Rheumatology 2022 (real-world)
[7]: Nash et al., Arthritis Rheumatol 2020
[8]: Mease et al., Ann Rheum Dis 2021
[9]: DrugPatentWatch.com (secukinumab/ixekizumab patents)
[10]: ASAS-EULAR Guidelines 2019, updated 2022