Bimekizumab: a dual IL-17A and IL-17F inhibitor for the treatment of psoriasis and psoriatic arthritis

ABSTRACT

Introduction

Interleukin (IL)-17 is critical in the pathogenesis of psoriasis and psoriatic arthritis (PsA) with most data suggesting that IL-17A alone was the key cytokine. However, in vitro and in vivo studies have suggested dual blockade of IL-17A and IL-17 F may be more effective than IL-17 A blockade alone. Bimekizumab is the first human monoclonal antibody to exert simultaneous specific inhibition of IL-17A and IL-17 F, and has been studied in several phase II/III trials for psoriasis and PsA.

Areas covered

Bimekizumab is not currently licensed for use. A literature search identified clinical trials examining the efficacy and safety of bimekizumab for psoriasis and PsA, and these were critically appraised.

Expert opinion

Clinical trials of bimekizumab have been promising, demonstrating a rapid onset of response and superior efficacy compared to three currently licensed biologics: secukinumab, ustekinumab, and adalimumab. Bimekizumab maintains a high level of efficacy with maintenance dosing intervals of 8 weeks, compared with 4 weeks for currently licensed IL-17A antagonists. No unexpected adverse events have been identified, although mild-to-moderate fungal infections occur in approximately 10%. Studies over longer time periods involving additional active comparators would be valuable in further defining the role of bimekizumab amongst currently available treatments.

KEYWORDS:

• Bimekizumab
• Il-17A
• Il-17F
• psoriasis
• psoriatic arthritis

Article highlights

• The IL-23/IL-17 pathway has been strongly implicated in the pathogenesis of psoriasis and psoriatic arthritis. Although a number of biologics are available to treat these diseases, some patients fail to respond to therapies or suffer a loss of response over time.

• Bimekizumab is the first developed biologic to specifically inhibit both IL-17A and IL-17F. Simultaneous blockade of these cytokines has the potential to be more effective than individual inhibition of either cytokine.

• Bimekizumab is not currently licensed for use, however published phase II and III trials have demonstrated promising results for the treatment of psoriasis suggesting it has a rapid onset of response and high level of response across both disease domains. Bimekizumab has consistently demonstrated a reliable safety profile and it appears to be well tolerated, albeit with an increased risk of developing fungal infections.

Acknowledgments

RB Warren is supported by the Manchester NIHR Biomedical Research Centre. A Al-Janabi is a Medical Research Council-funded Clinical Research Fellow.

Declaration of interest

RB Warren has received research grants from AbbVie, Almirall, Amgen, Celgene, Janssen, Lilly, Leo, Medac, Novartis, Pfizer and UCB. RB Warren has also received consulting fees from AbbVie, Almirall, Amgen, Arena, Astellas, Avillion, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, DiCE, GSK, Janssen, Lilly, Leo, Medac, Novartis, Pfizer, Sanofi, Sun Pharma, UCB and UNION. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One of the peer reviewers on this manuscript has received a research grant and speaker fee from UCB. A second peer reviewer on this manuscript declares to have acted on Advisory Boards for Abbvie, Celgene, Janssen Cilag, Lilly, Pfizer, MSD, Mundipharma, Novartis, Amgen, Leo, Sanofi, and UCB; Speaker Boards for Abbvie, Actelion, Celgene, Janssen Cilag, Leo, MSD, Novartis, Pfizer, and UCB; and conducted clinical studies on behalf of Abbvie, Actelion, Amgen, Celgene, Galderma, GSK, Janssen Cilag, Leo, Novartis, Pfizer, Regeneron, Sanofi and UCB. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.