Bimekizumab

How it works

It selectively inhibits both interleukin-17A and interleukin-17F, cytokines that drive inflammation in psoriatic and spondyloarthritic disease.

Prescribing in practice

• It increases susceptibility to infection, including oral candidiasis, and active serious infection (such as tuberculosis) must be excluded and treated before starting.
• It is given by subcutaneous injection under specialist rheumatology or dermatology supervision.
• It is associated with new onset or exacerbation of inflammatory bowel disease, so caution is needed in those with a history of IBD; live vaccines should be avoided during treatment.

Monitoring

Screen for tuberculosis and active infection before treatment and monitor for signs of infection, candidiasis and inflammatory bowel symptoms during therapy.

Counselling the patient

• Report signs of infection, including persistent mouth or throat soreness suggestive of thrush.
• Tell the team about any change in bowel habit such as diarrhoea or abdominal pain.
• Avoid live vaccines and keep other immunisations up to date before starting where possible.

Evidence & guidelines

Efficacy is demonstrated in phase 3 trials across its indications and supported by NICE technology appraisal guidance.