Bimekizumab for treating moderate to severe plaque psoriasis
NICE guidance states (1):
- Bimekizumab alone or with methotrexate, is recommended as an option for treating active psoriatic arthritis (defined as peripheral arthritis with 3 or more tender joints and 3 or more swollen joints) in adults whose condition has not responded well enough to disease-modifying antirheumatic drugs (DMARDs) or who cannot tolerate them. It is recommended only if they have had 2 conventional DMARDs and:
- at least 1 biological DMARD or
- tumour necrosis factor (TNF)-alpha inhibitors are contraindicated but would otherwise be considered
- assess response to bimekizumab after 16 weeks of treatment
- stop bimekizumab if the psoriatic arthritis has not responded adequately using the Psoriatic Arthritis Response Criteria (PsARC; an adequate response is an improvement in at least 2 of the 4 criteria, 1 of which must be joint tenderness or swelling score, with no worsening in any of the 4 criteria)
- if the PsARC response is not adequate but there is a Psoriasis Area and Severity Index (PASI) 75 response, a dermatologist should decide whether continuing treatment is appropriate based on skin response
- take into account how skin colour could affect the PASI score and make any adjustments needed
For more detailed guidance see NICE (October 2023). Bimekizumab for treating active psoriatic arthritis
Notes
- bimekizumab is a humanized monoclonal IgG1 antibody
- mechanism of action (dual inhibition of IL-17A and IL-17F) (2,3)
- selectively neutralizes both IL-17A and IL-17F
- along with IL-17A, IL-17F can also cooperate with tumor necrosis factor-alpha (TNF-alpha) in inducing the production of key pro-inflammatory keratinocyte mediators (3)
- mechanism of action allows a more extensive suppression of disease inflammation, with a greater reduction of gene expression, migration of inflammatory cells and production of proinflammatory cytokines than the isolated blockade of IL-17A (2)
- bimekizumab has no activity on IL-17E (thought to have anti-inflammatory properties), unlike the IL-17RA inhibitor brodalumab (2)
- is considered a new therapeutic approach for the treatment of moderate-to-severe psoriasis (2)
- bimekizumab has demonstrated superiority in all direct comparative clinical trials conducted, whether against ustekinumab (IL-12/23 inhibitor), adalimumab (TNF inhibitor) or secukinumab (IL-17A inhibitor), for the treatment of psoriatic arthritis (2)
Reference:
- NICE (October 2023). Bimekizumab for treating active psoriatic arthritis
- Freitas E, Torres T. Bimekizumab: the new drug in the biologics armamentarium for psoriasis. Drugs Context. 2021;10:2021-4-1.
- Chiricozzi A, De Simone C, Fossati B, Peris K. Emerging treatment options for the treatment of moderate to severe plaque psoriasis and psoriatic arthritis: evaluating bimekizumab and its therapeutic potential [published correction appears in Psoriasis (Auckl). 2019 Aug 15;9:73-74]