Bimzelx is the first dual inhibitor of IL-17A and IL-17F for plaque psoriasis

UCB Canada is introducing Bimzelx (bimekizumab 160 mg/mL) solution for subcutaneous (SC) injection. The humanized IgG1 monoclonal antibody is indicated for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy.1 Action Bimekizumab binds and neutralizes interleukin-17A (IL-17A), interleukin-17F (IL-17F) and IL-17AF cytokines. Levels of IL-17A and IL-17F are elevated in several immune-mediated inflammatory diseases. Neutralization of both IL-17A and IL-17F suppresses inflammation (in vitro) to a greater extent than inhibition of IL-17A alone. The mean terminal elimination half-life of bimekizumab is about 23 days.1 Dosage The recommended dosage of bimekizumab is 320 mg (given as 2 subcutaneous injections of 160 mg each) every four weeks for the first 16 weeks, then every eight weeks thereafter. For patients with a body weight ≥ 120 kg who do not achieve a complete skin response by Week 16, a dosage of 320 mg every four weeks (after Week 16) may be considered.1 Administration Bimekizumab is administered by SC injection into the thigh, abdomen or upper arm. It should not be injected into psoriasis plaques or areas where the skin is tender, bruised, red or indurated. Injection sites should be rotated. Patients may self-inject (into thigh or abdomen only) after proper training in SC injection technique.1 Adverse effects The most common adverse effects of bimekizumab are upper respiratory tract infections (14.5%, most frequently nasopharyngitis), mild/moderate oral/oropharyngeal candidiasis (7.3%, up to 23.6%), headache (3.3%) and injection site reactions (2.8%, erythema, edema, pain, bruising, swelling). Serious infections have been reported (0.3%); patients should be evaluated for tuberculosis infection before starting bimekizumab therapy. Bimekizumab has the potential to cause serious hypersensitivity reactions and immunogenicity. Cases of new or exacerbations of inflammatory bowel disease (ulcerative colitis, Crohn’s disease) were seen in clinical studies; the drug is not recommended in patients with inflammatory bowel disease.1 Drug interactions Inactivated or non-live vaccines can be safely administered during bimekizumab therapy, but live vaccines should be avoided. Bimekizumab therapy has the potential to lower exposure of medications metabolized by CYP450, which could result in a clinically significant effect on CYP450 substrates with a narrow therapeutic index (e.g., warfarin); consider therapeutic monitoring when bimekizumab therapy is started.1 Supplied Bimzelx (bimekizumab 160 mg/mL solution for SC injection) is available in a 1 mL autoinjector and a 1 mL prefilled syringe.1 Storage Bimzelx should be stored in a refrigerator (2°C–8°C) in the original carton to protect from light. It may be stored at room temperature (up to 25°C), protected from light, for a maximum of 25 days. Prefilled syringes or autoinjectors should not be put back in the refrigerator once they have reached room temperature. Bimzelx should not be frozen.1 Summary A 2021 Drugs review concluded that bimekizumab has shown superior efficacy over adalimumab (a TNF-alpha blocker), ustekinumab (an IL-12 and IL-23 inhibitor) and secukinumab (an IL-17A inhibitor) in direct comparative studies. In all phase 3 trials, bimekizumab was also well tolerated, with a safety profile similar to the other biologic drugs tested, except for a higher frequency of oral candidiasis. The article concluded that dual inhibition of IL-17A and IL-17F is a highly effective therapeutic option for the treatment of psoriasis, both for biologic-naïve patients and for those resistant to previous biologic treatments.2 A 2022 CADTH review also concluded that evidence from four clinical trials demonstrated that bimekizumab improves skin clearance compared with placebo and three other biologics: adalimumab, ustekinumab and secukinumab. However, the drug’s long-term safety and effectiveness are uncertain compared with other biologics for psoriasis because of the short duration of the clinical trials and other limitations in the evidence.3 References 1. UCB Canada Inc. Bimzelx (bimekizumab injection) product monograph. Oakville, Ont.; February 14, 2022. (accessed April 26, 2022). 2. Freitas E, Blauvelt A, Torres T. Bimekizumab for the treatment of psoriasis. Drugs 2021;81:1751-62. doi: 10.1007/s40265-021-01612-z. 3. CADTH Reimbursement Recommendation. Bimekizumab (Bimzelx). Can H Health Technol 2022;2(4). (accessed April 26, 2022).

Bimzelx is the first dual inhibitor of IL-17A and IL-17F for plaque psoriasis

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