Bimekizumab superior to secukinumab in psoriasis

The phase 3b trial BE RADIANT documented superior efficacy of dual IL-17A and IL-17F blockade with bimekizumab compared with an IL-17A-only blockade by secukinumab for the treatment of psoriasis.

BE RADIANT (NCT03536884) is the first phase 3 study in which an IL-17A/F blocker –bimekizumab– is compared with an IL-17A-only blocker – secukinumab [1]. “This trial will allow us to learn something about the role of IL-17F in the skin,” explained Prof. Kristian Reich (University Medical Center Hamburg-Eppendorf, Germany).

Both IL-17A and IL-17F are overexpressed in psoriasis and have a role in psoriasis pathogenesis. BE RADIANT was a head-to-head comparison between bimekizumab and secukinumab. Primary endpoint was complete healing of psoriasis skin lesions (PASI 100 response at week 16). In addition, efficacy and safety results after 48 weeks were assessed.

From week 16 onward, bimekizumab was applied either every 4 or every 8 weeks. At week 16, >60% of bimekizumab-treated patients achieved a PASI 100 response compared with 48.9% of patients treated with secukinumab (P<0.001). “After 48 weeks, the gap was even wider: 20% more patients treated with bimekizumab gained complete skin clearance compared with secukinumab,” Prof. Reich said. No difference in PASI 100 response was observed between the 2 dose intervals with bimekizumab. A similar pattern was seen for PASI 90 response, which was assessed as a secondary endpoint. Bimekizumab had a faster onset of treatment response than secukinumab: both the PASI 75 and PASI 90 response at week 4 were significantly higher with bimekizumab.

No new safety signals were observed. However, oral candidiasis was seen more frequently in patients treated with the dual IL-17 blocker: 19.3% versus 3.0% with secukinumab. Fortunately, 97.2% of oral candidiasis cases were mild to moderate, and none led to discontinuation of study treatment. “Hence, these study results suggest that for the optimal inhibition of the IL-17 pathway in psoriasis, both IL-17A and IL-17F need to be blocked. This approach is faster as well. This points to a relevant role of IL-17F in the pathogenesis of psoriasis,” Prof. Reich concluded.

1. Reich K, et al. Bimekizumab efficacy and safety versus secukinumab in patients with moderate to severe plaque psoriasis: Results from a multicenter, randomized, double-blinded, active comparator-controlled phase 3b trial (BE RADIANT). Session S033, AAD VMX 2021, 23-25 April.

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Posted on 7 June 202130 June 2021