In this installment of Discourses in Dermatology, G. Michael Lewitt, MD, and Omar Noor, MD, FAAD, discuss bimekizumab, highlighting the remarkable patient outcomes observed in their clinical practices, how it stands out in a crowded treatment landscape, and its significant implications for psoriasis management. 

A unique mechanism of action 

Psoriasis intricately involves pathways like IL-23, IL-17, and TNF alpha, with specific immune cells perpetuating the inflammatory cascade. Recognizing the diverse isomers of IL-17, particularly IL-17A and IL-17F, forms the foundation of bimekizumab's approach. Unlike other medications that target solely IL-17A or the IL-17 receptor, bimekizumab is a pioneering treatment that addresses both IL-17A and F, presenting a novel mechanism of action. 

Histological studies reveal elevated levels of IL-17F in psoriatic lesions, underscoring the significance of dual IL-17A and F inhibition. By precisely targeting these predominant isoforms, bimekizumab demonstrates enhanced efficacy in mitigating inflammation. 

Patient success stories in clinical practice 

Highlighting patient anecdotes, Dr Noor and Dr Lewitt underscore bimekizumab’s efficacy in challenging cases, from individuals resistant to conventional therapies to those weary from a carousel of treatments. 

Both Dr Lewitt and Dr Noor share that their patients on bimekizumab showed significant clearance of psoriatic lesions by the time they returned for a 4-week follow-up and were able to rekindle a sense of optimism toward their treatment journeys after multiple failed responses to other therapies. 

Counseling patients on adverse events 

Addressing concerns about adverse events, Dr Noor advocates for comprehensive patient communication. Acknowledging the increased rates of anxiety and depression at baseline in patients with psoriasis, he emphasizes the importance of prioritizing discussions on emotional well-being alongside treatment efficacy. He encourages colleagues to address any relevant medical history of major depressive disorders or antidepressant use to ensure bimekizumab is the right fit for a given patient. 

An approach to monitoring 

In terms of monitoring, Dr Noor adheres to standard biologics protocols, conducting CBC, CMP, and QuantiFERON-TB Gold tests at baseline along with an acute hepatitis panel to exclude the possibility of hepatitis B in patients. Dr Noor’s personal recommendation is to follow up with another CMP or LFT at 6 to 12 weeks, and if levels remain stable, repeat yearly going forward. 

A convenient dosing schedule 

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. 

Notably, this dosing schedule is unique to bimekizumab, offering an appealing option to patients who are concerned about the frequency of medication administration. This approach not only enhances patient compliance but also accommodates individual needs, particularly in the case of overweight patients who may need to remain on an every-4-week dosing schedule. 

Standing out in a crowded landscape 

Drs Lewitt and Noor conclude their discussion by reflecting on the crowded psoriasis treatment landscape. Despite the many options available, they acknowledge that persistent unmet needs remain. They remark that bimekizumab stands out by effectively addressing these needs through its distinct mechanism of action, rapid efficacy, and favorable safety profile, allowing them to maintain the commitment to prioritizing patient well-being amid the evolving landscape of psoriasis therapeutics.