Dr Craig Leonardi on Emerging Anti-IL-17 Biologic, Bimekizumab
Craig Leonardi, MD, is an associate clinical professor of dermatology at St. Louis University Medical School and in private practice at Central Dermatology in St Louis, MO. He is also a member of the National Psoriasis Foundation Medical Board. As a leading expert in dermatology, he continues to help advance the science of psoriasis through clinical trials and patient care.
Dr Leonardi met with The Dermatologist to discuss the latest evidence regarding bimekizumab, a novel biologic that inhibits both IL-17A and IL-17F, from a poster presented at the Academy of Managed Care Pharmacy Nexus 2021.1
To the best of your knowledge and based on the recent network meta-analysis,1 how does bimekizumab compare with currently available biologics for psoriasis?
We did a very interesting analysis. It is difficult to perform a head-to-head trial with every one of the possible biologics that exist, especially in a busy place like dermatology and psoriasis. So, what we did was construct a network meta-analysis. This is a statistical method that allows direct and indirect comparisons in a research trial environment. It is a very common and standard methodology that is well accepted.
Once we constructed the network, we then looked at the data in terms of numbers needed to treat (NNT). NNT refers to the average number of patients needed to achieve one additional good outcome. This is a user-friendly measurement of how well a therapy performs. With NNT, we can get answers to specific questions like, "What is the likelihood that the next patient I put on a drug will indeed be a success?"
What we concentrated on was Psoriasis Area and Severity Index (PASI) 90 and PASI 100 levels of clearance.
The network meta-analysis included 12 biologics: adalimumab, bimekizumab, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab. Using the published data regarding PASI 90/PASI 100, we performed the NNT calculations.
For the PASI 90 metric, we had a range of success rates. Etanercept, for example, had a NNT value of 4.61. This high number means the drug is performing poorly at the PASI 90 level. Interestingly, etanercept used to be a top, go-to drug in dermatology. It was the drug that we all learned to love, and now it is at the bottom of the ladder in terms of PASI 90 performance. At the top of the PASI 90 performance was bimekizumab 320 mg with an NNT of 1.22. This is a high-performance drug. In fact, almost every patient that goes on this medication, at least, the PASI 90 levels of clearance are in fact achieved.
PASI 100 had similar results. Again, etanercept had an NNT value of 16.77 at the PASI 100 level. This is a shocking number because again, for the longest time in our specialty, we only had etanercept as an option and sometimes even had to use it as part of insurance requirements. This NNT value of 16.77 indicates that you are going to have to treat 17 patients before the next one you treat is going to be completely clear. Essentially, if you are using a drug like etanercept with the idea that your patient is going to have complete clearance, your patient is likely to be upset and you are likely to be frustrated with the lack of results.
Now, the best PASI 100 value was 1.74, which belonged to bimekizumab. Remember that this means that almost every other patient will have complete clearance. This is a drug that gets the patients in a good place and keeps them there. I should also add that bimekizumab was the only biologic in this entire network meta-analysis that had PASI 100 NNT values that were less than two.
For patients who are in real trouble with their psoriasis and need additional help in clearing their skin, a drug such as bimekizumab may in fact provide some comfort for them as well as the physicians who are wrestling and exhausting therapeutic options trying to treat them. Although bimekizumab is not approved yet by the FDA, it is certainly an exciting potential option for psoriasis.
Reference
1. UCB presents number needed to treat analysis for bimekizumab in moderate to severe plaque psoriasis at AMCP Nexus. Press release. UCB; October 22, 2021. Accessed November 26, 2021. https://www.ucb-usa.com/stories-media/UCB-U-S-News/detail/article/ucb-presents-number-needed-treat-analysis-bimekizumab-in-Moderate-to-Severe-Plaque-Psoriasis-at-AMCP-Nexus
