Long-Term Effectiveness of Bimekizumab in Plaque Psoriasis: Two-Year Drug Survival from a Real-Life Multicenter Italian Study

Background: Bimekizumab, a monoclonal antibody targeting both IL-17A and IL-17F, has shown strong efficacy in moderate-to-severe plaque psoriasis. However, long-term real-world data on its effectiveness and treatment persistence remain limited. Objective: Evaluate the 2-year drug survival of bimekizumab in a real-life setting across multiple Italian dermatology centers. Methods: This multicenter, retrospective, observational study included adult patients with moderate-to-severe plaque psoriasis who initiated bimekizumab between May 2022 and November 2024. Drug survival was assessed using Kaplan-Meier analysis. Univariable and multivariable Cox regression models were used to identify predictors of treatment persistence. Results: Eight hundred twenty-six patients were included (66.6% male; mean age 52.3 ± 14.9 years). At baseline, the mean PASI score was 15.5 ± 8.9, which decreased to 1.4 ± 3.3 at the last follow-up. Estimated drug survival rates at 12, 18, and 24 months were 89.1%, 85.0%, and 82.4%, respectively. One hundred twenty-nine patients discontinued treatment, primarily due to adverse events (n=68) and ineffectiveness (n=31). In both univariable and multivariable analyses, male sex was significantly associated with a lower risk of discontinuation (HR 0.65, p = 0.002; HR 0.67, p = 0.008, respectively). Other factors, including BMI >30 kg/m2, presence of psoriatic arthritis, baseline PASI >15, and prior biologic exposure, were not significantly associated with treatment discontinuation. Conclusion: This real-world study demonstrates a long-term effectiveness and high drug survival of bimekizumab up to 24 months, across diverse patient profiles, regardless of BMI, disease severity, prior biologic exposure, or presence of psoriatic arthritis.