Dual biologic therapy in a patient with severe psoriasis and psoriatic arthritis, using guselkumab and bimekizumab: A case report and review of the literature

Dual biologic therapy is not often used in psoriasis and psoriatic arthritis due to cost and safety concerns, with limited literature supporting its use. We present a case of a 31-year-old man with severe plaque psoriasis and erosive psoriatic arthritis, refractory to multiple therapies. While guselkumab improved skin symptoms, joint inflammation persisted. Given the patient’s reluctance to discontinue guselkumab and his poor response to prior therapies, bimekizumab was added. This combination led to near-complete skin clearance and significant joint improvement within 3 months, with sustained benefits and no adverse effects at 17 months. This case illustrates how targeting multiple points in the interleukin-23/interleukin-17 pathway can improve outcomes in patients unresponsive to monotherapy. Dual biologic therapy may be a viable option for select patients with complex disease, though further research is needed to evaluate its long-term safety and efficacy.