COMMENTARY

Psoriasis Treatment With Biologics: 5 Things to Know

Caitlin G. Purvis; Steven R. Feldman, MD, PhD

Disclosures

June 14, 2021

4. Adherence can be an issue, even in patients taking injectable treatments.

As is the case with many chronic conditions, treatment adherence can prove challenging in patients with plaque psoriasis, particularly those with severe disease. Although adherence rates are higher for biologics than for other types of psoriasis treatments (eg, topical agents), they are still less than optimal. One nonintrusive way to assess a patient's adherence to self-administered biologics is to pose a simple, nonaccusatory question, such as, "Have you been making sure to keep the extra syringes you've accumulated refrigerated?" An affirmative response to this type of question probably means that the patient has extra syringes because they haven't adhered to their prescribed therapy schedule.

Direct physician-patient communication to determine patient preferences and educating patients on the effects and benefits of treatment may enhance and improve adherence to biologic therapies. In addition to such discussions, clinicians may employ psychological techniques such as anchoring to improve adherence. Anchoring — and resetting the anchor — may help patients feel comfortable beginning and continuing treatment. In one anchoring study, patients who were initially anchored to a daily injectable biologic were more amenable and comfortable taking a monthly injectable biologic.

5. A notable new biologic is on the horizon for psoriasis.

Among the biologics undergoing clinical trials for psoriasis and PsA, one in particular has shown promising results in treating plaque psoriasis and is currently pending FDA approval. Bimekizumab is a monoclonal antibody with a high affinity to selectively inhibit both IL-17A and IL-17F. Three studies published this year explored the safety and efficacy of bimekizumab for the treatment of psoriasis: BE READY, BE VIVID, and most recently, BE RADIANT.

BE READY compared bimekizumab with placebo; BE VIVID (a head-to-head study) compared bimekizumab with ustekinumab (an IL-12/23 blocker) and placebo; and BE RADIANT compared bimekizumab with secukinumab (an IL-17A blocker). In BE READY, bimekizumab treatment resulted in 90% or greater improvement in PASI in 91% of patients at week 16. In BE VIVID, 85% of the bimekizumab group had a PASI 90 vs 50% of the ustekinumab group at 16 weeks. Moreover, in BE RADIANT, bimekizumab was even more effective than secukinumab: At week 48, 67% of patients in the bimekizumab group had a PASI 100 compared with 46.2% in the secukinumab group. Further promising results were demonstrated in the earlier BE ACTIVE trial wherein bimekizumab was found effective for PsA, with 46% of patients having at least 70% improvement in the American College of Rheumatology score (ACR70) at week 48.

Despite these promising study results, safety concerns may exist. Although bimekizumab appeared quite safe in clinical trials, it was associated with a considerably higher rate of oral candidiasis than other biologics for psoriasis (19.3% vs 3% with secukinumab). Also, per findings from BE VIVID, serious treatment-emergent adverse events were reported in 24 of 395 patients, indicating that there may be other, as-yet unknown adverse effects that develop over time.

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