Study: Off-Label Dosing Shows Limited Benefit for Brodalumab, Bimekizumab in Psoriasis
Key Takeaways
- Off-label dosing modifications of brodalumab and bimekizumab generally offered limited benefit compared with approved regimens.
- Brodalumab dose reduction decreased long-term efficacy, while treatment interruption resulted in rapid relapse but high rates of response recapture after retreatment.
- Bimekizumab dose escalation produced only modest efficacy gains, with potential benefit primarily in higher-weight patients, while maintaining a favorable safety profile.
A systematic review published in Archives of Dermatological Research suggested deviations from approved dosing schedules offered limited clinical advantage in patients with plaque psoriasis, while maintaining similar safety.
Investigators reviewed randomized controlled trials and phase 3 or later open-label studies published between January 2014 and February 2026, ending up with comprising 6,725 patients meeting inclusion criteria.
Among patients receiving brodalumab, dose reductions resulted in 13% to 20% lower rates of static Physician Global Assessment (sPGA) 0/1 responses at Week 52 versus standard dosing. Withdrawal of therapy led to relapse within approximately 8 weeks; however, more than 90% of patients regained clinical response following retreatment. Investigators reported no dose-dependent safety signals.
For bimekizumab, dose escalation improved PASI 90 responses by >5% vs. approved dosing. Oral candidiasis occurred more frequently with intensified dosing. Median time to relapse was 28 weeks after treatment withdrawl.
"Brodalumab dose reductions reduce short-term efficacy and are not routinely recommended," they wrote in the abstract. "Bimekizumab dose escalation shows minimal added efficacy outside of high-weight patients. Brodalumab allows for rapid recapture of disease control, and bimekizumab may offer a longer drug-free duration before relapse. Limitations include lack of trials designed specifically for off-label dosing and cross-trial analyses."
Source
Kim D, et al. Archives of Dermatological Research. 2026;318:207.