In this episode of Discourses in Dermatology, Alice Gottlieb, MD, PhD, and James Q Del Rosso, DO, discuss bimekizumab, which has emerged as a distinctive and highly efficacious treatment option for psoriasis. Tune in to hear their comments on its unique features, efficacy, safety profile, and dosing advantages. 

What makes bimekizumab different? 

Dr Gottlieb describes the unique features that distinguish bimekizumab from other psoriasis treatments, noting the high level of efficacy that has been demonstrated in rigorous comparator studies and shown to be more efficacious than adalimumab and secukinumab. 

It is also currently the only IL-17 blocker with every-8-weeks dosing, which puts it in the range of the IL-23 blockers. 

Bimekizumab also possesses a novel mechanism of action as an IL-17A and F blocker, whereas agents like secukinumab and ixekinumab are IL-17A blockers only. 

Efficacy 

Dr Gottlieb notes that the majority of patients on bimekizumab reach PASI 75 by week 4, with Dr Del Rosso commenting that 4 out of 10 have been shown to achieve PASI 90 after a single dose. In a New England Journal of Medicine comparator study, 86% of patients taking bimekizumab achieved PASI 90 vs 47% of patients on adalimumab. 

Safety profile 

Candida 

In clinical trials, candida infections occurred more frequently in the bimekizumab group than in the placebo group, however, Dr Gottlieb notes that bimekizumab is a more potent drug than ixekinumab or secukinumab, thus a higher incidence of candida is to be expected and not cause for concern. 

Suicidal ideation and behavior 

Regarding the package insert statements on depression and suicide, Dr Gottlieb notes that the associated confidence interval numbers reflect that these potential adverse effects do not pose a significant concern. 

Liver function 

Treatment with bimekizumab was associated with increased incidence of liver enzyme elevations compared to treatment with placebo in randomized clinical trials. However, Dr Gottlieb notes that there have been rigorous double-blind, placebo-controlled comparator studies on bimekizumab against adalimumab, secukinumab, and ustekinumab, and bimekizumab did not demonstrate a higher incidence of liver function issues, with the incidence being low across all drugs in the studies. 

Tuberculosis 

Evaluating patients for tuberculosis prior to initiating treatment with bimekizumab is required; Dr Gottlieb typically opts to repeat the screen once per year. 

Inflammatory bowel disease 

Inflammatory bowel disease (IBD) has been reported in patients treated with IL-17 blockers, though Dr Gottlieb comments that the risk is relatively minimal. However, she notes that for patients with active IBD or a strong family history of IBD, she would likely consider an alternative therapy. 

Dosing 

The recommended dosing schedule for bimekizumab is administration of 320 mg (two 160-mg injections) at weeks 0, 4, 8, 12, and 16, then every 8 weeks thereafter. 

Dr Gottlieb remarks that this dosing schedule is one of the most notable advantages of bimekizumab, noting that it is currently the only IL-17-targeting agent that allows an every-8-weeks dosing schedule at maintenance. She commends the flexibility of adjusting dosing to every 4 weeks for patients weighing ≥120 kg. 

Key points: 

• Bimekizumab has demonstrated better efficacy than adalimumab and secukinumab in comparator studies 
• Bimekizumab possesses a novel mechanism of action as both an IL-17A and F blocker 
• Potential adverse effects such as candida infections, suicidal ideation and behavior, and liver biochemical abnormalities may not pose significant cause for concern in patients taking bimekizumab 
• For patients with active IBD or a strong family history of IBD, alternative therapies may be considered 
• The recommended dosing for bimekizumab is a major advantage over other treatments, offering a convenient and flexible schedule