What are the key points to discuss during bimekizumab (Bimekizumab) counseling for patients with plaque psoriasis?

Key Counseling Points for Bimekizumab in Plaque Psoriasis

Bimekizumab is a highly effective dual IL-17A/F inhibitor that should be recommended for patients with moderate-to-severe plaque psoriasis, particularly those with relevant skin involvement impacting quality of life or extensive disease. 1

Mechanism of Action and Efficacy

• Bimekizumab is a humanized IgG1 monoclonal antibody that selectively inhibits both interleukin-17A and interleukin-17F 2
• Clinical efficacy highlights to discuss with patients:
  • Superior to adalimumab and secukinumab in achieving complete skin clearance 3, 4
  • Rapid onset of action with significant improvement often seen within 4 weeks 4
  • High rates of complete skin clearance (PASI 100) maintained through 96 weeks of treatment 5
  • Effective for difficult-to-treat areas including scalp, nails, and palmoplantar psoriasis 1

Dosing and Administration

• Initial dosing: 320 mg administered subcutaneously at weeks 0,4,8,12, and 16 2
• Maintenance dosing: 320 mg every 8 weeks (may require every 4 weeks in some patients) 6
• Self-administered subcutaneous injection using prefilled syringe or autoinjector 2
• Higher dosing may be required for patients weighing ≥120 kg due to lower plasma concentrations 2

Safety Considerations

Common Side Effects

• Upper respiratory tract infections
• Oral candidiasis (more common than with other biologics)
• Diarrhea
• Hypertension 3

Important Safety Warnings

• Increased risk of infections, particularly oral candidiasis (predominantly mild to moderate) 4
• Tuberculosis screening required before initiating therapy
• Live vaccines should not be given during treatment
• Inactivated vaccines appear to maintain normal immune response 2

Monitoring Requirements

• Baseline tuberculosis screening before initiating therapy
• Regular assessment of treatment response and adverse events
• No specific laboratory monitoring requirements, but general health monitoring recommended

Immunogenicity

• Anti-drug antibodies may develop in approximately 45% of patients with plaque psoriasis
• Neutralizing antibodies occur in approximately 16% of patients
• Current evidence suggests antibodies do not significantly impact efficacy or safety 2

Special Considerations

• May be particularly beneficial for patients with:
  • Concomitant psoriatic arthritis 1, 7
  • Extensive skin involvement or disease in visible/sensitive areas 1
  • Inadequate response to TNF inhibitors 1
• Avoid in patients with active infections
• Similar efficacy in both TNF-naïve and TNF-experienced populations 1

Practical Aspects

• Store in refrigerator (2-8°C/36-46°F)
• Allow to reach room temperature before injection (approximately 30 minutes)
• Rotate injection sites
• Dispose of used needles/syringes properly

Treatment Expectations

• Patients should understand that while bimekizumab provides high clearance rates, it is not a cure
• Treatment interruption typically leads to disease recurrence
• Maintenance therapy is required for continued benefit 6
• Tapering may be considered in patients achieving sustained remission 1