Background Ankylosing spondylitis (AS) is a chronic immune-mediated inflammatory disease primarily affecting the sacroiliac joints and spine, causing pain, stiffness and loss of mobility and function. These manifestations can severely impair patients’ quality of life (QoL).1 Dual neutralisation of IL–17F in addition to IL-17A has been shown to reduce inflammation to a greater extent than inhibition of IL-17A alone in disease–relevant cell models.2 Results previously reported from this Phase 2b study (NCT02963506) demonstrated that, during the 12-week double-blind treatment period, bimekizumab provided substantial clinical improvements in disease outcome measures, including Assessment of SpondyloArthritis international Society 40% (ASAS40), in patients with active AS.3
Objectives To assess the impact of bimekizumab on patient-reported and QoL outcomes at Week 12 in patients with active AS.
Methods In this 48-week Phase 2b study (double blind to Week 12 then dose blind to Week 48), 303 patients with active AS (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] ≥4; spinal pain ≥4 [0–10 numerical rating scale]), fulfilling the modified New York criteria, were randomised 1:1:1:1:1 to receive subcutaneous bimekizumab 16mg, 64mg, 160mg, 320mg or placebo Q4W for 12 weeks. Prior exposure to one anti-TNF therapy was permitted. Secondary and other endpoints included: BASDAI, ≥50% improvement in BASDAI (BASDAI 50), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life (ASQoL) and Patient’s Global Assessment of Disease Activity (PGADA) at Week 12. Safety was also assessed.
Results Overall, 297 (98.0%) patients completed the 12-week double-blind period. Baseline scores on patient-reported and QoL outcomes were similar across treatment groups (Table). At Week 12, BASDAI 50 was achieved by 23.7–47.5% of bimekizumab-treated patients versus 11.9% receiving placebo. All bimekizumab doses were associated with greater reductions in individual BASDAI components, including: fatigue (range: -1.6 to –2.5 vs -0.8); neck, back or hip pain (-2.0 to -3.3 vs -1.2); discomfort due to tenderness to touch or pressure (-1.6 to -3.0 vs -1.1); level of morning stiffness (-2.5 to -3.5 vs -1.2) and duration of morning stiffness (-1.7 to -3.3 vs -1.4) (Table). Compared with placebo, greater reductions from baseline were also achieved with bimekizumab for BASFI (-1.4 to -2.2 vs –0.6), ASQoL (-2.3 to -4.6 vs -1.3) and PGADA (-1.9 to -3.3 vs -1.0). The overall incidence of treatment-emergent adverse events was 89/243 (36.6%) for bimekizumab-treated patients versus 23/60 (38.3%) for placebo; the majority were of mild or moderate intensity. No unexpected safety findings were observed.
Conclusion Dual neutralisation of IL-17A and IL-17F with bimekizumab was associated with improvements in patient-reported and QoL outcomes including pain, fatigue and tenderness in patients with active AS after 12 weeks of treatment. No new safety findings were observed versus previous studies of bimekizumab.3,4
Reference  Kotsis Expert Rev Pharmacoecon Outcomes Res 2014;14:857–72; 2Glatt Ann Rheum Dis 2018;77:523–32; 3van der Heijde Ann Rheum Med 2018;77(Suppl 2):70.
Disclosure of Interests Désirée van der Heijde Consultant for: AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, Union Chimique Belge, Lianne S. Gensler Grant/research support from: Abbvie, Amgen, UCB Pharma, Consultant for: Novartis, Lilly, Janssen, Atul Deodhar Grant/research support from: AbbVie, Amgen, Eli Lilly, GSK, Janssen, Novartis, Pfizer, and UCB, Consultant for: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Xenofon Baraliakos Grant/research support from: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Centocor, Chugai, Janssen, MSD, Novartis, Pfizer Inc, Roche and UCB, Grant/research support from: AbbVie, Pfizer, Merck Sharp & Dohme, UCB Pharma, Novartis, Consultant for: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Chugai, Janssen Biologics, Novartis, Pfizer, UCB Pharma, Galapagos, Speakers bureau: AbbVie, Chugai, Janssen, Novartis, Pfizer, UCB Pharma, Denis Poddubnyy Grant/research support from: AbbVie, Merck Sharp & Dohme, Novartis, Consultant for: AbbVie, Bristol-Myers Squibb, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, UCB Pharma, Speakers bureau: AbbVie, Bristol-Myers Squibb, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, UCB Pharma, Mary Katherine Farmer Employee of: UCB Pharma, Dominique Baeten Shareholder of: UCB Pharma, Employee of: UCB Pharma, Jason Coarse Employee of: UCB Pharma, Marga Oortgiesen Shareholder of: UCB Pharma, Employee of: UCB Pharma, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma
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