Head-to-Head PsA Trial Data May Inform Skin-Joint Treatment Decisions

Dermatology clinicians often spend significant time talking with patients about how psoriasis affects their daily lives—not only the visible plaques but also the aches, stiffness, and fatigue that sometimes accompany the disease. Because of that role, these clinicians are frequently among the first to recognize when a patient with psoriasis may be developing psoriatic arthritis (PsA).¹

New top-line results from the BE BOLD trial provide a direct comparison between 2 biologic therapies used in psoriatic disease: bimekizumab (Bimzelx; UCB) and risankizumab (Skyrizi; AbbVie). Although the complete results have not yet been presented, the study reported that bimekizumab achieved a higher rate of a 50% improvement in American College of Rheumatology criteria (ACR50) at week 16 than risankizumab among adults with active PsA.

For dermatology clinicians who help guide treatment discussions and monitor symptoms over time, the findings highlight the ongoing evolution of biologic therapy for patients whose disease affects both skin and joints.

Why PsA Conversations Often Start in Dermatology

Many patients do not initially connect joint symptoms with their psoriasis. During routine follow-up visits, clinicians may hear comments such as the following:

• “My fingers feel stiff in the morning.”
• “My heel hurts when I first get out of bed.”
• “One of my toes keeps swelling up.”

These seemingly small complaints can be early clues to PsA.

PsA affects an estimated 0.02% to 0.25% of the population, and approximately 30% of individuals with psoriasis may develop it at some point. The disease can involve multiple manifestations, including peripheral joint inflammation, enthesitis (pain where tendons attach to bone), dactylitis (swollen fingers or toes), and skin disease.³

Because dermatology clinicians often see patients regularly for psoriasis management, they are in a key position to identify these symptoms and coordinate evaluation with rheumatology colleagues.

A Trial Comparing 2 Biologic Strategies

The BE BOLD trial was designed to compare the effectiveness of 2 different inflammatory pathway targets in PsA. The randomized, double-blind study enrolled 553 adults with active PsA. Participants were either biologic naive or had previously tried 1 tumor necrosis factor inhibitor but had an inadequate response or could not tolerate it. Patients were assigned to receive either bimekizumab or risankizumab.

The primary outcome was ACR50 at week 16, which measures whether patients achieve at least a 50% improvement in joint tenderness and swelling, along with improvements in other disease measures such as pain scores, physical function, and inflammatory markers.

According to the top-line analysis, bimekizumab showed statistically significant superiority for the ACR50 end point at week 16. Investigators also reported that treatment was generally well tolerated during this initial period and that no new safety signals were identified.

More detailed efficacy and safety data are expected when the full results are presented at a future medical meeting.

Understanding the Different Pathways

The therapies evaluated in the trial act on different immune pathways involved in psoriatic disease. Bimekizumab targets 2 inflammatory cytokines: IL-17A and IL-17F. These molecules contribute to inflammatory signaling in both skin and joints. Risankizumab targets IL-23, a cytokine that sits earlier in the inflammatory cascade and plays a major role in psoriasis development.

Both pathways are established targets in dermatology and rheumatology treatment strategies. However, direct comparisons between therapies working through these different mechanisms are relatively uncommon, which is why head-to-head trials such as BE BOLD attract attention among clinicians.

What Dermatology NPs and PAs May Want to Watch For

Because the currently released information represents top-line data, several practical questions remain unanswered. Clinicians will likely be interested in details such as the following:

• Whether improvements in joint symptoms were accompanied by similar improvements in skin disease
• How the therapies compared across specific PsA manifestations, such as enthesitis or dactylitis
• Whether patients who had previously used biologic therapies responded differently than biologic-naive participants

These factors can influence treatment discussions with patients who have both skin and joint involvement.

Translating Clinical Trials to Patient Conversations

Clinical trials often focus on structured end points, but dermatology clinicians frequently frame treatment decisions around patient experiences. Patients may ask questions such as the following:

• “Will this medication help my joint pain and my skin?”
• “How long does it usually take to notice improvement?”
• “What happens if the medication stops working?”

Understanding how therapies perform in comparative studies can help clinicians provide clearer explanations during these discussions. At the same time, trial results represent controlled research settings, and individual responses can vary in clinical practice.

Looking Ahead

The BE BOLD trial will continue through additional follow-up, and investigators plan to present the complete data set, including detailed efficacy outcomes and safety findings, at an upcoming international congress.

For dermatology clinicians involved in managing patients with psoriasis, the study adds another piece of information to consider when discussing biologic treatment options and monitoring for signs of PsA.

As more comparative data become available, these clinicians will continue to play an important role in recognizing musculoskeletal symptoms, guiding patient education, and coordinating care across dermatology and rheumatology specialties.

References

1. Chakith M R S, Pradeep S, Gangadhar M, et al. Advancements in understanding and treating psoriasis: a comprehensive review of pathophysiology, diagnosis, and therapeutic approaches. PeerJ. 2025;13:e19325. doi:10.7717/peerj.19325
2. Bimzelx (bimekizumab) superior to Skyrizi (risankizumab) in BE BOLD: first head-to-head study in active psoriatic arthritis (PsA) to demonstrate superiority in ACR50. News release. UCB. March 11, 2026. Accessed March 16, 2026. https://www.ucb.com/newsroom/press-releases/article/bimzelxrvbimekizumab-superior-to-skyrizir-risankizumab-in-be-bold-first-head-to-head-study-in-active-psoriatic-arthritis-psa-to-demonstrate-superiority-in-acr50
3. Ogdie A, Weiss P. The epidemiology of psoriatic arthritis. Rheum Dis Clin North Am. 2015;41(4):545-568. doi:10.1016/j.rdc.2015.07.001