Abstract
Axial spondyloarthritis is a chronic rheumatic disease affecting the axial skeleton, peripheral joints and extra- articular structures. The goal of treatment is to suppress inflammatory activity and prevent structural damage in order to minimize pain and stiffness and to preserve mobility and good quality of life of the patients.
Interleukins (IL) 17A and 17F are pro-inflammatory cytokines that play an important role in the pathogenesis of axial spondyloarthritis. IL-17F is elevatedly expressed in patients with axial spondyloarthritis, although it is biologically less active than IL-17A.
However, combined inhibítion of both of these cytokines has shown better efficacy in reducing inflammatory activity in in vitro experiments than inhibition of either cytokine alone. Bimekizumab is the first monoclonal antibody that selectively inhibits the interaction of both IL-17A and IL-17F with their receptors.
Its efficacy and safety háve been demonstrated in dinical trials in patients with axial spondyloarthritis. Patients treated with bimekizumab achieved a significantly greater improvement in ASAS (Assessment of SpondyloArthritis International Society) clinical response and reduction in objective markers of inflammation than patients taking placebo.
Treatment was effective independently of prior therapy and bimekizumab was generally well tolerated. The most common adverse effects were nasopharyngitis and upper respirátory tract infections.
Fungal infectíons were seen more frequently than in placebo arm, but serious infections and cardiovascular events were rare. Based on these clinical trials, bimekizumab was approved for the treatment of ankylosing spondylitis, non-radiographic axial spondylo-arthritis and active psoriatic arthritis.
Comparative clinical trials are not yet available to conclude that combined IL-17A and IL-17F inhibítion is more effective in spondyloarthritis, as has been demonstrated in psoriasis. Overall, bimekizumab is an effective and well-tolerated biologie for patients with axial spondyloarthritis and represents a new hope in the treatment of this disease