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IL-17A and IL-17F Inhibitor Pregnancy: Avoid — insufficient data; animal studies showed no teratogenicity but immunoglobulin-class drugs cross placenta; effective contraception required

Bimekizumab

Brand names: Bimzelx

Adult dose

Dose: 320 mg SC every 4 weeks for 16 weeks; then every 8 weeks (maintenance)
Route: Subcutaneous injection
Frequency: Every 4 weeks (induction) then every 8 weeks (maintenance)
Max: 320 mg per dose
Moderate-severe plaque psoriasis; also licensed for PsA and axial spondyloarthritis; dual IL-17A and IL-17F inhibition

Paediatric dose

Dose: Not established N/A/kg
Route: N/A
Frequency: N/A
Max: N/A
Not licensed in paediatrics

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Not licensed in paediatrics

Clinical pearls

  • BE VIVID (NEJM 2021): bimekizumab superior to ustekinumab and placebo — PASI 90 achieved in 85% vs 50% (ustekinumab) at week 16; first head-to-head trial showing superiority over established biologic
  • Dual IL-17A and IL-17F inhibition: IL-17F contributes significantly to psoriatic inflammation — blocking both cytokines explains the consistently higher PASI 90/100 response rates vs IL-17A-only inhibitors (secukinumab, ixekizumab)
  • MHRA 2023 approved; NICE TA878 for plaque psoriasis; oral candidiasis higher rate vs secukinumab (~20%) — counsel patients, treat topically, rarely requires discontinuation
  • Avoid in IBD patients — IL-17 inhibition can worsen Crohn's disease; screen for GI symptoms before starting; if IBD develops, permanently discontinue
  • BE RADIANT trial (PsA): high ACR50 and MDA rates — MHRA 2023 extended licence to PsA, positioning bimekizumab as a versatile IL-17 inhibitor across the psoriatic disease spectrum

Contraindications

  • Active tuberculosis
  • Serious active infections
  • Inflammatory bowel disease (may worsen)
  • Known hypersensitivity

Side effects

  • Nasopharyngitis (most common)
  • Upper respiratory tract infections
  • Oral candidiasis (higher rate than IL-17A-only inhibitors)
  • Injection site reactions
  • IBD exacerbation
  • Tinea infections

Interactions

  • Live vaccines — avoid
  • CYP450 substrates — IL-17 inhibition may normalise CYP450 enzyme levels; monitor warfarin, ciclosporin

Monitoring

  • TB screening before initiation
  • FBC and LFTs (baseline)
  • Signs of infection
  • IBD symptoms
  • Oral candidiasis (each visit)

Reference: BNFc; BNF 90; BE VIVID trial (Reich et al. NEJM 2021); NICE TA878; MHRA SPC Bimzelx 2023; BE RADIANT trial (McInnes et al. Lancet 2023). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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