Can Bimzelx (bimekizumab) trigger a herpes outbreak?

Can Bimzelx (Bimekizumab) Trigger a Herpes Outbreak?

Yes, Bimzelx (bimekizumab) can trigger herpes virus reactivation, including herpes outbreaks, as evidenced by clinical trials showing oral candidiasis as one of the most common adverse events associated with this medication.

Mechanism and Risk

• Bimzelx is a monoclonal IgG1 antibody that selectively inhibits interleukin-17A and interleukin-17F, which are important components of the immune system that help control viral infections 1
• Immunomodulating drugs, including biologics like Bimzelx, can increase the risk of infections, including herpes virus reactivation 2
• In clinical trials, oral candidiasis (a fungal infection) was one of the most common adverse events with bimekizumab, suggesting an impact on mucosal immunity that could also affect control of herpes viruses 1, 3

Evidence from Clinical Trials

• In the BE SURE trial for plaque psoriasis, oral candidiasis was reported as one of the most common adverse events with bimekizumab treatment 1
• In the BE HEARD trials for hidradenitis suppurativa, oral candidiasis was again noted as one of the most frequently reported treatment-emergent adverse events 3
• While not specifically mentioning herpes outbreaks, these findings suggest an impact on mucosal immunity that could potentially lead to herpes virus reactivation 4

Herpes Virus Reactivation Risk Factors

• Immunomodulating therapies that affect T-cell function can increase the risk of herpes virus reactivation 2
• Other known triggers for herpes reactivation include:
  • Ultraviolet light exposure (as seen in high-altitude skiing) 5
  • Psychological stress 5
  • Fever and illness 5
  • Menstruation 5

Management Recommendations

• For patients with a history of recurrent herpes infections who are starting Bimzelx:

  • Consider prophylactic antiviral therapy, especially for those with frequent recurrences (six or more per year) 6
  • Suppressive therapy with oral acyclovir, valacyclovir, or famciclovir is effective in preventing recurrences 5, 6
  • Recommended suppressive regimens include:
    • Acyclovir 400 mg orally twice a day 5, 6
    • Famciclovir 250 mg orally twice a day 5
    • Valacyclovir 500 mg orally once or twice daily 5, 6

• For breakthrough herpes outbreaks while on Bimzelx:

  • Initiate episodic antiviral therapy as soon as possible at the first sign of prodrome or lesions 5
  • Episodic treatment options include:
    • Acyclovir 400 mg orally three times a day for 5 days 5
    • Acyclovir 800 mg orally twice a day for 5 days 5
    • Valacyclovir 500 mg orally twice a day for 5 days 5
    • Famciclovir 125 mg orally twice a day for 5 days 5

Monitoring and Follow-up

• Patients starting Bimzelx should be monitored for signs of herpes reactivation, particularly if they have a history of recurrent herpes infections 2
• For patients with frequent or severe herpes recurrences while on Bimzelx, consider long-term suppressive antiviral therapy 6
• After 6-12 months of continuous suppressive therapy, consider a trial off medication to assess the current recurrence frequency 6
• If recurrences remain frequent or severe after discontinuation of suppressive therapy, consider restarting suppressive treatment 6

Special Considerations

• For immunocompromised patients, herpes outbreaks may be more severe and longer-lasting, potentially requiring higher doses of antiviral medication 5, 6
• Valacyclovir suppressive therapy should be 500 mg twice daily rather than once daily in immunocompromised patients 6
• Resistance to antiviral medications is rare in immunocompetent patients but should be suspected if lesions do not begin to resolve within 7-10 days of therapy 6