Does Bimzelx Increase Risk of Fungal Infections?
Bimzelx (bimekizumab-bkzx), an IL-17A and IL-17F inhibitor for plaque psoriasis, psoriatic arthritis, and axial spondyloarthritis, carries warnings for serious infections, including fungal ones. The prescribing information lists candidiasis (thrush or other yeast infections) as a common side effect, occurring in up to 10.5% of patients in clinical trials—higher than placebo rates of 1-3%. Invasive fungal infections like aspergillosis or histoplasmosis are rare but possible due to IL-17's role in antifungal immunity.[1]
What Clinical Trial Data Shows on Fungal Risks
In phase 3 trials (BE VIVID, BE READY, BE RADIANT), oral candidiasis affected 7.4-14.6% of Bimzelx users versus 0.9-3.3% on placebo or ustekinumab. Most cases were mild to moderate, resolving with antifungal treatment without stopping Bimzelx. No trial discontinuations occurred due to fungal infections alone, but monitoring is required.[1][2]
Why Does Bimzelx Affect Fungal Defenses?
IL-17 cytokines protect against fungi like Candida by recruiting neutrophils and enhancing mucosal barriers. Blocking them, as Bimzelx does, impairs this response, similar to other IL-17 inhibitors like secukinumab (Cosentyx). Patients with history of recurrent infections face higher risks.[1]
How Common Are Serious Fungal Infections?
Serious cases (e.g., esophageal candidiasis or disseminated infections) are infrequent (<1%), but the label warns of opportunistic infections in immunocompromised patients. Pre-treatment screening for latent infections like histoplasmosis is advised in endemic areas.[1]
What Should Patients Watch For and Do?
Symptoms include white patches in mouth/throat, difficulty swallowing, or persistent fever. Report to doctors immediately; temporary Bimzelx holds and antifungals like fluconazole often suffice. Avoid if active infection exists. Prophylactic oral hygiene reduces candidiasis odds.[1][3]
How Does Bimzelx Compare to Other IL-17 Inhibitors?
| Drug | Oral Candidiasis Rate | Serious Fungal Risk |
|------|-----------------------|---------------------|
| Bimzelx | 7-15% | Low (<1%) [1] |
| Cosentyx (secukinumab) | 1-7% | Low [4] |
| Taltz (ixekizumab) | 1-3% | Very low [5] |
Bimzelx shows higher candidiasis rates, possibly due to dual IL-17A/F blockade.
Who Is at Higher Risk?
Those with diabetes, prior candidiasis, or in humid climates/endemic fungal zones (e.g., Ohio/Mississippi River valleys). No pediatric data yet; not recommended under 18.[1]
Sources
[1]: Bimzelx Prescribing Information (FDA)
[2]: BE VIVID Trial (NEJM)
[3]: UpToDate: IL-17 Inhibitors and Infections
[4]: Cosentyx Label (FDA)
[5]: Taltz Label (FDA)