Bimekizumab for treating axial spondyloarthritis

Bimekizumab is recommended as an option in adults for treating active ankylosing spondylitis (AS) when conventional therapy has not worked well enough or is not tolerated, or active non‑radiographic axial spondyloarthritis (nr‑axSpA) with objective signs of inflammation (shown by elevated C‑reactive protein or MRI) when non-steroidal anti‑inflammatory drugs (NSAIDs), have not worked well enough or are not tolerated. It is recommended only if:

• tumour necrosis factor (TNF)-alpha inhibitors are not suitable or do not control the condition well enough, and

• the company provides it according to the commercial arrangement.

Assess response to bimekizumab after 16 weeks of treatment. Continue treatment only if there is clear evidence of response, defined as:

• a reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score to 50% of the pre-treatment value or by 2 or more units, and

• a reduction in the spinal pain visual analogue scale (VAS) by 2 cm or more.

Take into account any communication difficulties, or physical, psychological, sensory or learning disabilities that could affect responses to the BASDAI and spinal pain VAS questionnaires, and make any appropriate adjustments.

If people with the condition and their clinicians consider bimekizumab to be 1 of a range of suitable treatments (including ixekizumab and secukinumab), after discussing the advantages and disadvantages of all the options, use the least expensive. Take account of administration costs, dosage, price per dose and commercial arrangements.

This recommendation is not intended to affect treatment with bimekizumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation 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.