Bimekizumab Leads New Wave of PsA Comparative Data: Philip Mease, MD

Clinicians choosing among psoriatic arthritis (PsA) therapies gained new comparative evidence at ACR Convergence 2026, held November 6-11 in Orlando, Florida, led by 24-week results from BE BOLD, the first head-to-head trial of IL-17A/F versus IL-23 inhibition, in which bimekizumab (Bimzelx) maintained a higher ACR50 response than risankizumab (Skyrizi).¹˒² Philip J. Mease, MD, director of rheumatology research at Providence Swedish Medical Center and clinical professor at the University of Washington School of Medicine, discussed BE BOLD alongside an indirect comparison of 2 oral agents and a real-world analysis of skin outcomes.

During the meeting, Mease said head-to-head trials remain rare in PsA and are the gold standard for positioning drugs, particularly as many patients move from a tumor necrosis factor (TNF) inhibitor to an IL-17 or IL-23 inhibitor. BE BOLD (NCT06624228) randomized 553 adults with active PsA who were biologic-naive or TNF inhibitor-experienced to bimekizumab (n = 277) or risankizumab (n = 276), building on week 16 results first presented at EULAR 2026.¹

“So what we have here are 2 very good drugs with an ACR50 response better in the [bimekizumab] arm, but in some of the other measures similarity between the , and so I think this is reassuring for patients to see the quality and degree of effect there is,” Mease said.

ACR50 at week 16, the primary endpoint, was 49.1% with bimekizumab versus 38.0% with risankizumab (P = .0058), and 54.9% versus 43.8% at week 24 (nominal P = .0059).¹˒² Minimal disease activity (MDA) was numerically but not significantly higher with bimekizumab at week 16 (P = .39), and week 24 PASI100 rates were similar (59.7% vs 59.1%). Serious adverse events occurred in 1.8% versus 3.3% of patients, with more mild to moderate Candida infections with bimekizumab (2.9% vs 0.7%).

Where head-to-head trials are lacking, Mease pointed to a matching-adjusted indirect comparison of SELECT-PsA 1 and POETYK PsA-1 data found upadacitinib 15 mg outperformed deucravacitinib (Sotyktu) 6 mg at week 16 for ACR50 (difference, 21.5%; 95% CI, 12.5%–30.6%), ACR70, and minimal disease activity (all P < .001), with a nonsignificant ACR20 difference.² Safety outcomes did not differ significantly, and Mease noted the upadacitinib boxed warning stems largely from tofacitinib data.

In real-world Adelphi data from 1,372 patients, physician-reported skin outcomes with upadacitinib were comparable to TNFi and IL-17 inhibitors regardless of prior TNFi exposure.³ Mease said such data help him counsel patients on expected skin response across mechanisms. Both upadacitinib analyses involved AbbVie-affiliated authors, and these congress data have not been peer reviewed.

Relevant disclosures include AbbVie, Acelyrin, Amgen, BMS, Century, Cullinan, Eli Lilly and Company, Inmagene, Johnson & Johnson Innovative Medicine, Moonlake, Novartis, Pfizer, Sana, Spyre, Takeda, and UCB.

References

1. McInnes I, Gossec L, Gottlieb A, et al. Bimekizumab efficacy & safety versus risankizumab in patients with active psoriatic arthritis: 24-week results from a head-to-head, multicenter, randomized, phase 3b study. Abstract 2804. Presented at: ACR Convergence 2026; November 6-11, 2026; Orlando, FL.

2. Mease P, Park TJ, Ismail W, et al. Comparative efficacy and safety of upadacitinib versus deucravacitinib in biologic-naïve patients with psoriatic arthritis: a matching-adjusted indirect comparison. Abstract 1309. Presented at: ACR Convergence 2026; November 6-11, 2026; Orlando, FL.

3. Mease P, Tillett W, Ye X, et al. Real-world comparative effectiveness of upadacitinib versus tumor necrosis factor inhibitors or interleukin-17 inhibitors on skin symptoms in patients with psoriatic arthritis. Abstract 1356. Presented at: ACR Convergence 2026; November 6-11, 2026; Orlando, FL.