Efficacy and safety of bimekizumab compared with other available treatments in PsA: A network meta-analysis

Bimekizumab is an interleukin 17 (IL-17) inhibitor and is approved in Europe for use in psoriatic arthritis (PsA) in adults.¹ Bimekizumab has shown efficacy in the phase III trials BE OPTIMAL (disease-modifying anti-rheumatic drug [DMARD]-naïve patients) and BE COMPLETE (tumor necrosis factor inhibitor [TNFi] inadequate responder patients), which has previously been covered on the Psoriasis and Psoriatic Arthritis Hub.¹

Here, we summarize a network meta-analysis by Mease et al.¹ in Oxford Rheumatology, which evaluated the efficacy and safety of bimekizumab for patients with PsA compared with 21 other biologic or targeted synthetic DMARDs (b/tsDMARDs).¹

Methods¹

• The meta-analysis (latest update on January 1, 2023) was designed to identify studies evaluating the efficacy and safety of bimekizumab 160 mg every 4 weeks (Q4W) vs other available PsA treatments.
• Two analyses were performed: one for b/tsDMARD-naïve and one for TNFi-experienced patients with PsA.
• In each patient population, the American College of Rheumatology 20%/50%/70% improvement responses (ACR20/50/70), Psoriasis Area and Severity Index (PASI) score of 90/100, and minimal disease activity score were analyzed. Serious adverse events analysis was conducted in a mixed population.
• Studies were selected if data were available at Week 16; if not, data at Weeks 12, 14, or 24 were used.
• Surface under the cumulative ranking curve (SUCRA) values were used to determine relative rank of treatments.

Key findings¹

• Of the 66 studies selected for data extraction, 41 studies met the inclusion criteria.

Joint outcomes

• In b/tsDMARD-naïve patients, bimekizumab 160 mg Q4W was better in ACR50 (SUCRA = 0.74) than placebo, abatacept 125 mg, guselkumab 100 mg Q4W, ustekinumab 45 mg, risankizumab 150 mg, guselkumab 100 mg every 8 weeks, and ustekinumab 90 mg, but it was worse than golimumab 2 mg. Bimekizumab 160 mg Q4W ranked 6th for ACR20 (SUCRA = 0.75), 5th for ACR50 (SUCRA = 0.74), and 3rd for ACR70 (SUCRA = 0.80) among 21 treatments. Bimekizumab was comparable to the remaining treatments in the network.
• In TNFi-experienced patients, bimekizumab was ranked 1st among 16 treatments for ACR70 (SUCRA = 0.83) and was better than placebo, abatacept 125 mg, secukinumab 150 mg without loading dose, tofacitinib 5 mg, and secukinumab 150 mg; and it was comparable to the remaining treatments on ACR50.

Skin outcomes

• In b/tsDMARD-naïve patients, bimekizumab was ranked 1st of 11 treatments for PASI 100 (SUCRA = 0.95) (Figure 1A). In TNFi-experienced patients, bimekizumab was ranked 2nd of 7 treatments for PASI 100 (SUCRA = 0.79) (Figure 1B).

Minimal disease activity score

• Bimekizumab was ranked the 1st among the 13 treatments in b/tsDMARD-naïve patients (SUCRA = 0.91) and 11 treatments in TNFi-experienced patients (SUCRA = 0.83).

Safety

• Safety outcomes were found to be comparable across all treatments evaluated

b/ts DMARD, biological or targeted synthetic disease-modifying anti-rheumatic drug; Q4W, every 4 weeks; Q8W, every 8 weeks; PASI, Psoriasis Area and Severity Index; SUCRA, surface under the cumulative ranking curve; TNFi, tumor necrosis factor inhibitor.

*Adapted from Mease, et al.¹ 

Key learnings

Bimekizumab 160 mg Q4W has demonstrated relatively favorable efficacy and comparable incidence of adverse events vs other treatments, suggesting it as a potentially beneficial treatment option in patients with PsA. Indirect comparisons in this analysis are not a substitute for head-to-head trials comparing treatments; additional analyses of b/tsDMARD-naive and TNFi-experienced subgroups would assist healthcare decision making in different clinical settings.