1.1 Bimekizumab is recommended as an option for treating plaque psoriasis in adults, only if:
the disease is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10 and
the disease has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated and
the company provides the drug according to the commercial arrangement.
1.2 Stop bimekizumab treatment at 16 weeks if the psoriasis has not responded adequately. An adequate response is defined as:
a 75% reduction in the PASI score (PASI 75) from when treatment started or
a 50% reduction in the PASI score (PASI 50) and a 5‑point reduction in DLQI from when treatment started.
1.3 Choose the least expensive treatment if patients and their clinicians consider bimekizumab to be one of a range of suitable treatments (taking into account availability of biosimilar products, administration costs, dosage, price per dose and commercial arrangements).
1.4 Take into account how skin colour could affect the PASI score and make any appropriate clinical adjustments.
1.5 Take into account any physical, psychological, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI and make any appropriate adjustments.
1.6 These recommendations are not intended to affect treatment with bimekizumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Why the committee made these recommendations
Bimekizumab is an alternative to other biological treatments already recommended by NICE for treating severe plaque psoriasis in adults. Evidence from clinical trials shows that bimekizumab is more effective than adalimumab, secukinumab and ustekinumab. Indirect comparisons suggest that bimekizumab is similarly or more effective than other biological treatments.
For the cost comparison, it is appropriate to compare bimekizumab with brodalumab, risankizumab and ixekizumab because they work in a similar way and would likely be used as an alternative to those treatments. The total costs associated with bimekizumab are similar to or lower than those associated with brodalumab, risankizumab and ixekizumab. Therefore, bimekizumab is recommended as an option for severe plaque psoriasis that has not responded to systemic non-biological treatments, or if these are contraindicated or not tolerated.