Potential association between IL-17A inhibition and blood pressure reduction in patients with axial spondyloarthritis

This study aimed to investigate longitudinal changes in blood pressure associated with IL-17A inhibition in patients with axial spondyloarthritis (ax-SpA).

This was a single-center, prospective, single-arm exploratory study that included 50 axSpA patients who received the IL-17A inhibitor Ixekizumab (160 mg loading dose at week 0, followed by 80 mg every 4 weeks for 12 weeks). Disease activity (ASDAS-CRP, ASDAS-ESR, BASDAI), inflammatory markers (CRP, ESR, IL-6), and blood pressure were monitored at baseline and every 4 weeks after treatment initiation. A linear mixed-effects model was used to analyze longitudinal changes in blood pressure.

IL-17A inhibition significantly improved disease activity and reduced inflammatory marker levels (all p < 0.001). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) all showed time-dependent decreases. Linear mixed-effects models estimated a reduction of 0.90 mmHg every 4 weeks for SBP (95% CI: -1.87 to 0.07, p = 0.071) and 0.91 mmHg per month for DBP (95% CI: -1.64 to -0.17, p = 0.016). Subgroup analysis showed that the rate of DBP decline was more pronounced in patients with baseline hypertension (n=36). After 12 weeks, SBP and DBP were decreased by 4.80 mmHg and 5.10 mmHg, respectively. No obvious side effects were observed in hematological, hepatic or renal function tests (both p < 0.01).

In this exploratory pilot study, IL-17A inhibition was associated with effective control of disease activity and a concomitant, time-dependent reduction in blood pressure in patients with ax-SpA. Linear mixed-model analysis suggested this reduction was particularly evident for DBP in patients with baseline hypertension. These findings provide preliminary clinical evidence supporting further investigation into the potential cardiovascular modulatory effects of IL-17A-targeted therapy. However, the uncontrolled design necessitates confirmation in randomized trials.