Background/Purpose: While biologic switching is common in routine clinical practice, limited information exists on switching within class from another IL-17i to bimekizumab. We conducted a real-world study of bimekizumab use in the setting of prior IL-17i exposure.

Methods: Our multicenter retrospective review of four institutions in Canada included adult plaque psoriasis patients initiated on bimekizumab following prior exposure to another IL-17i. Effectiveness outcomes, including Investigator Global Assessment (IGA), Psoriasis Area and Severity Index (PASI), body surface area (BSA), and IGAxBSA scores, were measured at week 16±6. Safety was assessed via treatment-related adverse events (AEs).

Results: A total of 43 patients were included; mean age was 44.4 (range: 18-63) years, with 53.5% (23/43) being female. Prior IL-17i agents included secukinumab (62.8%, 27/43), ixekizumab (39.5%, 17/43), and brodalumab (37.2%, 16/43); 32.6% (14/43) utilized ³2 IL-17i agents. Reasons for prior IL-17i discontinuation included inefficacy (88.4%, 38/43), patient preference (7%, 3/43), psoriatic arthritis flare (2.3%, 1/43), and adverse event (AE; 2.3%, 1/43). Primary non-response to prior IL-17i was defined as lack of IGA 0/1 and/or 75% improvement in PASI (PASI75) at week 16, whereas secondary non-response to prior IL-17i was defined as loss of IGA 0/1 and/or PASI75 response at any point afterwards.

At week 16±6: IGA 0/1 was achieved by 96.8% (30/31); mean PASI, BSA, and IGAxBSA improvements from baseline were 94.5% (9.3 to 0.5), 89.2% (8.7% to 0.7%), and 91.4% (24.4 to 1.7), respectively; 97.7% (42/43), 83.7% (36/43), and 62.8% (27/43) achieved PASI75, 90% improvement in PASI (PASI90), and 100% improvement in PASI (PASI100), respectively; 97.7% (42/43), 90.7% (39/43), 79.1% (34/43) achieved absolute PASI scores < 3, < 2, and < 1; and 76.7% (33/43) achieved BSA <1%. In prior IL-17i primary non-responders (n=14), 85.7% (12/14) achieved IGA 0/1 and/or PASI90 and 64.3% (9/14) achieved PASI100 with bimekizumab treatment at week 16±6. In prior IL-17i secondary non-responders (n=15), 93.3% (14/15) achieved IGA 0/1 and/or PASI90 and 73.3% (11/15) achieved PASI100 with bimekizumab treatment at week 16±6. Concomitant systemic therapy was utilized in 14% (6/43) of patients.

Two treatment-related AEs occurred (4.7%, 2/43), both being oral candidiasis; neither led to treatment discontinuation. No serious infections, suicidal ideation/behavior, malignancies, hypersensitivity  reactions, major adverse cardiac events, or hepatic abnormalities were observed.

Conclusion: In the BE RADIANT open-label extension study, IGA 0/1, PASI90, and PASI100 responses were 95.7%, 50.9%, and 20.8%, respectively, at week 4 for secukinumab PASI90 non-responders who switched to bimekizumab following a 48-week randomization period. Our results at week 16±6 are comparable for IGA 0/1 (96.8%) and superior for PASI90 (83.7%) and PASI100 (62.8%). Notably, our real-world study included prior IL-17i primary non-responders, while phase III clinical trials excluded this population. Our results highlight the utility of bimekizumab for patients with prior IL-17i exposure. Study limitations include its small sample and retrospective nature.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-world-experience-of-bimekizumab-for-plaque-psoriasis-in-adult-patients-with-prior-exposure-to-interleukin-17-inhibitors-a-16-week-multicenter-retrospective-review/