Rapid and sustained clearance of severe psoriasis with dual inhibition of IL-17A and IL-17F
Ron Vender, MD, FRCPC, presents the case of a 31-year-old male with an 8-year history of severe psoriasis who was frustrated with the lack of effective treatment options.
By Ron Vender, MD, FRCPC
Case Presentation and Medical History Summary
The patient is a manual laborer with a previous medical history of anxiety, alcohol abuse, and an 8-year history of psoriasis with unknown exacerbating factors. The patient reported no family history of psoriasis, psoriatic arthritis, or inflammatory bowel disease.
At the time of presentation, the patient was on an anxiolytic and reported a penicillin allergy.
To control the psoriasis, he had previously tried topical corticosteroids and calcipotriol/betamethasone dipropionate gel but never attempted phototherapy due to lack of access.
The patient had been previously enrolled in a Phase II RCT for an oral PDE4 inhibitor but saw no response after 16 weeks. He felt his participation in the trial was a waste of time and declined involvement in further RCTs.
Physical Exam and Lab Results
The physical exam results were within normal limits with the exception of the presence of numerous sharply demarcated scaly plaques on the patient’s trunk, elbows, knees, face, scalp, hands, and nails.
The patient’s oral mucosa was clear; a chest X-ray was also clear with no evidence of granulomatous lung disease.
An ultrasound revealed fatty liver changes, and liver function tests revealed aspartate aminotransferase and alanine transaminase elevated under 2x the upper limit of normal. Lipid testing revealed triglycerides levels at 50% above the upper limit of normal.
A QuantiFERON test to identify active and latent tuberculosis infection was negative.
Diagnostic Review
Considering the patient’s symptoms and history, a clinical diagnosis of plaque psoriasis was straightforward. The patient was assessed as having a body surface area (BSA) score of 11% and a Psoriasis Area and Severity Index (PASI) score of 17.4.
Many treatment options were reviewed with the patient, including a discussion on the various classes of medications available for psoriasis. However, he expressed frustration with the inadequate response he experienced with previous treatment attempts, and thus preferred to try the latest option approved for psoriasis that offered the fastest opportunity for improvement. He expressed concerns about durability and a preference for infrequent injections.
Which of the following is the recommended dosing for bimekizumab?
Before & After Photos
Treatment Discussion and Outcome
After a thorough review of available options and taking the patient’s treatment history and concerns into consideration, bimekizumab was selected as the optimal choice for managing the patient’s psoriasis. Candida was discussed as a potential adverse effect, but due to the low probability of occurring, this was not of particular concern to the patient when weighed against the potential benefits.
The patient was started on bimekizumab 320 mg. After receiving 2 doses of bimekizumab, the patient began seeing significant positive results and had achieved a PASI-90 response and BSA score of 3% at 2-week follow-up. The patient conveyed immense satisfaction with how quickly he began seeing improvement on bimekizumab.
After receiving 4 doses of bimekizumab, the patient achieved PASI 100 at 16-week follow-up.
The patient did not experience any adverse events or injection site reactions while taking bimekizumab, and oral mucosa was clear on each follow-up visit. The patient has remained on bimekizumab 320 mg every 8 weeks and has maintained clearance.
Following years of worsening symptoms and inadequate response to other treatments, the patient expressed substantial satisfaction with the rapid response to bimekizumab and the lack of adverse events, reporting a substantial improvement to mental health and quality of life.
Do you have a compelling patient case to share? Contact jnolan@dermsquared.com for details.