It is the first and only approved psoriasis treatment designed to selectively inhibit two key cytokines driving inflammatory processes—interleukin (IL)-17A and IL-17F.
Now, a new French study looks at whether the drug is effective for palmoplantar pustulosis (PPP) and palmoplantar plaque psoriasis with pustules, which remain challenging to treat.
Researchers from Universitaire de Nice, the Université Côte d’Azur, both in Nice, and colleagues pointed out that an IL-17 or IL-36 loop acts synergistically in those diseases to induce palmoplantar pustules.
The study team sought to assess the effectiveness of bimekizumab in treating PPP and palmoplantar plaque psoriasis with pustules. The results were published in the Journal of the American Medical Association Dermatology.
The small case series involved 21 adults. Eleven patients with PPP and 10 patients with palmoplantar plaque psoriasis with pustules were treated at one of seven tertiary dermatological centers in France from September 2022 through June 2023. The analysis included all patients treated with bimekizumab for at least 3 months.
The main outcome was defined as the posttreatment Investigator Global Assessment (IGA), scored as 0 (complete clearance), 1 (almost clear), 2 (mild), 3 (moderate), or 4 (severe). In addition, the evolution of joint pain and nail involvement was reported when relevant, while tolerance and potential adverse events were also recorded.
The participants had a mean age of 46 years, and all of them—except for two who received bimekizumab as their first systemic therapy—had not responded to at least one systemic treatment (median [range], 3 [1-7] treatments), and/or had adverse events leading to the discontinuation of the treatment.
The results indicated that complete clearance (IGA score, 0) was achieved by 17 patients in 1 to 4 months. Another three patients achieved an IGA score of 1, and one achieved an IGA score of 2.
Three patients with PPP also presented with acrodermatitis continua of Hallopeau—a rare inflammatory disease characterized by pustular eruptions beginning in the tips of fingers and toes. After 4 to 6 months of bimekizumab treatment, nail involvement showed 50% to 70% improvement.
Two patients had SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, but both of them also had complete clearance of skin lesions associated with joint pain improvement. Four patients (19%) with candidiasis were successfully treated with oral antifungal agents.
The authors noted that none of the patients had to stop bimekizumab treatment due to adverse events.
“The findings of this case series suggest that bimekizumab could be an appealing approach for treating PPP, palmoplantar plaque psoriasis with pustules, and SAPHO syndrome,” the researchers wrote. “Prospective randomized placebo-controlled clinical trials are needed to confirm these encouraging initial results.”
Background information in the article explained that, among the types of localized pustular psoriasis, PPP is defined as primary, persistent (>3 months), sterile, macroscopically visible pustules on palms or soles that can occur with or without psoriasis vulgaris, according to the ERASPEN Network consensus statement.
Those lesions, which can occur on a background of normal or inflamed skin, are painful, disabling, and can be accompanied by fissures, pruritus, and a burning sensation. The patient’s quality of life often is profoundly affected, the authors pointed out.
“The term PPP has been applied to several entities, suggesting heterogeneous underlying pathophysiological pathways,” the authors added. “In some cases, PPP is associated with bone and joint inflammation in SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. Additionally, palmoplantar plaque psoriasis with pustules is a localized plaque psoriasis with the co-occurrence of pustules. In addition to this heterogeneity, there is continuing controversy over whether PPP is a localized form of pustular psoriasis or a psoriasis-related disease.”
The problem, according to the report, is that available treatments for PPP and palmoplantar plaque psoriasis with pustules “remain unsatisfactory, likely because multiple immune pathways are simultaneously activated in these conditions. Acitretin can be of some help in some patients and remains for many physicians the first systemic approach. Cyclosporine remains the best option available, but it is not always effective and tolerance is often poor, with frequent and sometimes severe adverse events that often prevent its long-term use.”
The authors added that available biologic agents, including antitumor necrosis factor, anti–IL-12, anti–IL-17A, and anti–IL-23, improve disease in approximately one-third of patients with PPP, but “the disease remains a therapeutic challenge.”
Bimekizumab is an anti–IL-17A and anti–IL-17F antibody therapy that has been useful for treating psoriasis and psoriatic arthritis, the researchers advised, adding that some preliminary data suggest that bimekizumab reduces IL-36 levels in the serum by simultaneously blocking IL-17A and IL-17F, which led to their efforts.
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