Real-World Usage of Biologics in Psoriatic Arthritis

Continuing the Managed Healthcare Executive Between the Lines series, moderator Philip Mease, MD, of Swedish Medical Center, Providence St. Joseph Health, and the University of Washington, and guest Saakshi Khattri, MD, of the Icahn School of Medicine at Mount Sinai, shift from the broader disease burden discussion to how biologics are actually being used in practice today, before laying out the design of the BE BOLD trial.

Dr. Khattri describes her own prescribing pattern in New York City, where she's often able to start active psoriatic arthritis (PSA) patients on a biologic as first-line systemic therapy, a shift from the older paradigm of trying methotrexate or another conventional synthetic DMARD first. Dr. Mease notes the same trend holds even outside major academic hubs, pointing out that methotrexate alone often falls short on both efficacy and tolerability, and that the latest ACR guidelines now support using a biologic ahead of methotrexate. Dr. Khattri adds a practical note on access: when payers push back on biologics as first-line PSA therapy, she can sometimes secure approval through a patient's psoriasis diagnosis instead, since methotrexate isn't standard treatment for skin disease. The conversation then turns to the BE BOLD trial itself, the first head-to-head study of bimekizumab, a dual IL-17A/F inhibitor, and risankizumab, an IL-23 inhibitor, using a joint-centric ACR50 response as its primary endpoint. Dr. Mease walks through the Phase 3b, multicenter design, presented at the recent EULAR meeting in London, including its 553 adult participants, who were either biologic-naive or had an inadequate response to a prior TNF inhibitor, the 1:1 randomization to each drug at labeled dosing, and the hierarchy of secondary endpoints, including minimal disease activity, ACR50 plus PASI100, an early ACR50 read at week 4, and DAPSA low disease activity or remission. Dr. Khattri weighs in on how closely the trial population mirrors her own patients and explains why raising the efficacy bar from ACR20 to ACR50, along with capturing response as early as week 4, matters for setting realistic expectations with patients.

Up next, Dr. Mease and Dr. Khattri dig into the actual BE BOLD data, breaking down how bimekizumab and risankizumab performed head-to-head across these efficacy and safety endpoints.