Emerging Plaque Psoriasis Agents: Bimekizumab

Jerry Bagel, MD, MS: Bimekizumab is awesome. We did clinical trials with that as well. Its PASI 90 [90% reduction in the Psoriasis Area and Severity Index] is close to 90%. There’s nothing like it. It’s administered 320 mg, either every 4 weeks or every 8 weeks, it hasn’t been decided yet. But an 8-week dosage works just about as well as every 4 weeks. You have a drug that’s an IL [interleukin]-17A/F monoclonal antibody that works probably as good, maybe better, than an IL-23. It didn’t show any inflammatory bowel disease or ulcerative colitis in its clinical trials like with the other IL-17s, but I bet the FDA still lumps it with inflammatory bowel disease. One thing that was a little troublesome was 20% of all patients developed candidiasis, yeast infections: mouth, vaginal, and skin. Almost none of them discontinued bime [bimekizumab] because of it, but it needs to be looked at, treated, and we’ll see how we deal with it. Dermatologists, we deal with yeast, so we know how to handle that, but the thing is we had 1 patient who had it with each dose. We had to treat them with Diflucan [fluconazole] right before, and that covered it. That was helpful. I think of it very highly, and it has really good PsA [psoriatic arthritis] data, really good. So you have another drug coming out that is going to be very helpful. Again though, there’s going to be a certain percentage of people who don’t clear, and they’ll still have some residual psoriasis.

Assuming that the candidiasis is just a mild issue, which we didn’t see many cases, I think that bimekizumab would be my No. 1 IL-17. I’m not afraid to say it. And I think Taltz [ixekizumab] is a really good drug, and I think brodalumab, even though it has a black-box warning for suicide, is a good drug. But I think bimekizumab probably has better efficacy, and probably would be my No. 1 IL-17. And I would now start discussing deucravacitinib with my patients as an oral option, which before I wouldn’t. So there would be an oral option, an IL-17, and probably an IL-23 that I would choose from. That would be my selective group right there.

Transcript edited for clarity.