Bimekizumab

How it works

It selectively binds and neutralises both interleukin-17A and interleukin-17F, two pro-inflammatory cytokines central to the keratinocyte activation and inflammation that drive psoriatic plaques.

Prescribing in practice

• Dual IL-17 inhibition carries a notable risk of mucocutaneous candidiasis (especially oral candidiasis), and the patient should be screened and treated if infection occurs.
• Screen for active and latent tuberculosis and exclude active infection before starting, and avoid live vaccines during treatment.
• Use with caution in patients with a history of inflammatory bowel disease, as IL-17 inhibition has been associated with new or worsening IBD.

Monitoring

Monitor for signs of infection, candidiasis and new or worsening inflammatory bowel symptoms throughout treatment and review response against psoriasis severity scores.

Counselling the patient

• Report sore mouth, white patches, or other signs of thrush, as well as any signs of infection.
• Tell the team about any new or worsening bowel symptoms such as diarrhoea or abdominal pain.
• Avoid live vaccines while on treatment and discuss vaccination needs in advance.

Evidence & guidelines

NICE has recommended bimekizumab for moderate-to-severe plaque psoriasis, supported by the BE VIVID and BE RADIANT phase 3 trials.