From Skin to Joints: Clinical Impact of a Dual-Targeted Approach

From Skin to Joints: Clinical Impact of a Dual-Targeted Approach

In this episode of Topical Conversations, Erin Boh, MD, and Benjamin Lockshin, MD, discuss the role of bimekizumab (Bimzelx), the first dual IL-17A/F inhibitor, in the management of patients with psoriasis (PsO) and psoriatic arthritis (PsA). The conversation highlights how this mechanism of action has the potential to reshape treatment strategies, particularly for patients with both extensive skin involvement and active joint disease.

Treatment considerations in PsO and PsA

Dr Boh explains that her initial considerations include the extent of skin involvement and the presence of comorbidities such as joint disease. These parameters help guide whether therapy should be directed primarily toward skin, joints, or both. She emphasizes a patient-centered approach directed by understanding whether skin or joint symptoms are the main driver of discomfort.

For patients with both extensive skin and joint disease, she typically favors IL-17 inhibitors or IL-23 inhibitors over TNF inhibitors, noting that TNFs may struggle to achieve high levels of skin clearance in such cases.

Advances with bimekizumab

Dr Lockshin notes that while treatments over the past 2 decades have been highly effective for skin clearance, progress in joint clearance has been more limited. Bimekizumab introduces a new approach with its dual inhibition of IL-17A and IL-17F, demonstrating robust results in both skin and joints.

He highlights that bimekizumab is the first drug to use an American College of Rheumatology criteria for 50% response (ACR50) score as a primary endpoint in PsA trials, providing a more meaningful measure of response compared to ACR20. Clinical trial data showed achievement of ACR20, ACR50, and ACR70 responses in some patients faster than in timelines observed with other agents.

Dr Boh agrees, noting that while other IL-17 inhibitors are effective for joint disease, there are subsets of patients who respond incompletely. In her view, bimekizumab represents not only a new drug but a new therapeutic class, with the potential to maximize outcomes in patients who do not achieve adequate improvement with IL-17A inhibition alone.

Practical implications and switching therapy

Both Dr Boh and Dr Lockshin emphasize the potential benefit of of switching therapy. Dr Lockshin states he has no reservations about moving patients from a TNF inhibitor to an IL-17, or from an IL-17A inhibitor to dual IL-17A/F blockade with bimekizumab.

Dr Boh highlights the potential role of bimekizumab when combination therapy is otherwise limited by access or insurance barriers. For example, if a patient has partial response to an IL-17A, switching to bimekizumab may offer greater improvement without the need for additional agents.

Patient-centered decision-making

The discussion concludes with a reminder from Dr Boh that treatment decisions should be patient-first: the patient comes first, the disease second, and the drug third. With an expanding set of options, including bimekizumab, dermatologists are better positioned to tailor treatment to each patient’s unique presentation, balancing efficacy across both skin and joint disease while considering mechanisms of action and long-term outcomes.

Key takeaways

• Initial considerations: Treatment decisions in PsO and PsA begin with assessing the extent of skin involvement and the presence of joint disease
• Dual inhibition: Bimekizumab targets both IL-17A and IL-17F, offering robust efficacy in skin and joint clearance
• Clinical trials: In bimekizumab trials for PsA, ACR50 was used as a primary endpoint, a more clinically meaningful measure than ACR20
• Therapeutic flexibility: Switching from TNF inhibitors or single-pathway IL-17 inhibitors to bimekizumab can maximize outcomes without requiring combination therapy
• Patient-centered care: The patient’s priorities drive treatment (skin versus joints), with bimekizumab representing an option that addresses both domains effectively