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In the first-ever head-to-head trial comparing two major biologics for psoriatic arthritis, bimekizumab (Bimzelx) outperformed risankizumab (Skyrizi) on the primary joint symptom endpoint — but risankizumab had a cleaner safety profile. The BE BOLD trial showed bimekizumab's advantage was most pronounced early on, with skin outcomes converging by week 24. Notably, the trial was sponsored by bimekizumab's manufacturer, UCB.
The BE BOLD trial — the first head-to-head study comparing an IL-17A/F inhibitor with an IL-23 inhibitor in psoriatic arthritis (PsA) — has a winner, with some caveats. Bimekizumab (Bimzelx) beat risankizumab (Skyrizi) on the primary endpoint of ACR50 response at week 16 (49.1% vs. 38%), with the advantage appearing as early as week 4 and holding through week 24. Skin outcomes, however, largely converged by the end of the study, and risankizumab's safety profile was more favorable.
The trial randomized over 550 PsA patients equally to both drugs. Researchers noted that bimekizumab's downstream mechanism — blocking IL-17A/F directly — may explain its faster onset, while risankizumab's upstream IL-23 inhibition appears to catch up over time, particularly for skin-related outcomes. The trial was sponsored by UCB, bimekizumab's manufacturer.
By the Numbers:
Why it matters: With both drugs already approved for PsA, clinicians now have the first comparative efficacy data to guide treatment decisions — though industry sponsorship and converging long-term outcomes mean the full picture warrants careful consideration.
