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Objectives To explore real-world effectiveness of ixekizumab in Danish patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA).Methods Observational cohort study based on data from the Danish nationwide quality registry, DANBIO. Patients with axSpA and PsA initiating ixekizumab (an interleukin 17 inhibitor (IL-17i)) between 2017 and 2024 were included. Outcomes were 6-, 12- and 24-month retention rates and low disease activity (LDA)/remission after 6 months (axSpA: Axial Spondyloarthritis Disease Activity Score (ASDAS) <2.1/<1.3, PsA: Disease Activity index for Psoriatic Arthritis (DAPSA28) ≤14/≤4, respectively). Clinical factors associated with retention were explored (multivariable Cox regression analyses with adjusted HRs (aHRs)).Results 709 patients were included (axSpA: 231, PsA: 478). Most patients were bio-experienced (axSpA: 97%, PsA: 91%). The 6-, 12- and 24-month retention rates were for axSpA: 69% (95% CI 63; 76), 53% (46; 60) and 40% (33; 49); for PsA: 75% (71; 79), 63% (58; 67) and 51% (46; 57), respectively. Patients previously treated with another IL-17i (axSpA 36%, PsA 34%) had an increased risk of withdrawal (aHR: axSpA 1.48 (1.01; 2.17), PsA 2.38 (1.79; 3.15)). Smoking, radiographic status (axSpA) or concomitant methotrexate (PsA) were not associated with withdrawal. After 6 months, 24% of axSpA patients had ASDAS-LDA, and 5% were in ASDAS-remission. For PsA, DAPSA28-LDA was achieved in 43% and DAPSA28-remission in 10%, respectively.Conclusion In this nationwide observational study, ixekizumab was primarily prescribed in patients who had failed multiple biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs), including other IL-17i. Retention rates were somewhat lower for axSpA than for PsA. For both axSpA and PsA, prior IL-17i treatment was associated with an increased risk of withdrawal, yet the relatively high retention rate and improvement in all disease activity outcomes suggest ixekizumab as a viable option for patients with multiple b/tsDMARD failures.