The Axial Advantage: Expanding Psoriasis Care Across Indications

In this episode of Topical Conversations, E. James Song, MD, speaks with Tina Bhutani, MD, about bimekizumab and its growing list of indications, including psoriasis, psoriatic arthritis (PsA), axial spondyloarthropathies, and hidradenitis suppurativa (HS), highlighting how this therapy may help dermatologists address the multifaceted needs of patients.

Why another biologic?

Dr Song opens by noting that bimekizumab is now the twelfth biologic approved for psoriasis, prompting the question of why additional biologics are still needed. Dr Bhutani stresses that despite the abundance of options, many patients cycle through therapies due to inadequate response or secondary failure. Moreover, patients often present with comorbidities such as joint disease that require broader treatment coverage, demonstrating the value of having multiple biologics available to personalize care.

Bimekizumab in psoriatic arthritis

PsA presents unique challenges, with many patients responding inconsistently or slowly to traditional therapies. Dr Bhutani explains that even when skin clearance is achieved, joint symptoms often remain uncontrolled. They explain that bimekizumab provides another option for these patients, adding to the armamentarium for both dermatologists and rheumatologists managing PsA.

Addressing axial spondyloarthropathies

The conversation turns to axial disease, specifically radiographic axial spondyloarthritis (axSpA, also known as ankylosing spondylitis) and nonradiographic axSpA (nr-axSpA). Dr Bhutani explains that these conditions involve inflammation of the central joints, particularly the spine and sacroiliac joints. Historically, treatment was limited until radiographic changes became apparent.

Dr Song highlights the significance of bimekizumab’s approval for nr-axSpA, which allows earlier intervention before structural damage occurs. He contrasts IL-23 inhibitors, which have limited efficacy in axial disease, with IL-17 inhibitors like bimekizumab, which demonstrate consistent benefit across both peripheral and axial domains. Together, Drs Song and Bhutani emphasize that bimekizumab covers nearly all GRAPPA domains (skin, nails, enthesitis, dactylitis, peripheral joints, and axial disease) making it a versatile option for patients with overlapping manifestations.

Expanding to hidradenitis suppurativa

The discussion closes with a look at bimekizumab’s approval in HS, a often difficult condition to manage. Dr Bhutani shares her clinical experience, noting rapid improvements in pain and inflammatory lesions, with the potential to reduce long-term complications such as scarring and tunneling. She emphasizes that patients with HS stand to benefit greatly from having more therapeutic options in what remains an area of significant unmet need.

Key takeaways

• Ongoing need for new biologics: Despite many approved options, patients often require alternative therapies due to nonresponse or secondary failure
• PsA management: Bimekizumab offers an additional option for patients with joint disease
• Axial disease coverage: Approval in nr-axSpA allows earlier intervention and highlights IL-17 inhibitors as more effective than IL-23 inhibitors in axial domains
• Comprehensive domain coverage: Bimekizumab has potential to address nearly all GRAPPA domains, offering broad utility in patients with overlapping manifestations
• HS treatment: Bimekizumab provides meaningful benefit in a challenging disease, with potential to improve quality of life and prevent long-term complications