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New BIMZELX® (bimekizumab-bkzx) Data at ACR Convergence 2024 Highlights UCB’s Efforts to Deliver Differentiated Care for Patients with Psoriatic Arthritis and Axial Spondyloarthritis

This Press Release is Intended for Media and Investor Stakeholders Only

  • ACR Convergence 2024 marks UCB’s first presentation of data in psoriatic arthritis (PsA), non-radiographic axial spondyloarthritis (nr-axSpA), and ankylosing spondylitis (AS) since the recent approvals of BIMZELX® (bimekizumab-bkzx) in these indications in the U.S.
  • New two-year data demonstrated sustained improvements in clinical and 
    patient-reported outcomes in PsA, nr-axSpA, and AS patients treated with BIMZELX
  • UCB will present 19 BIMZELX abstracts, including two oral presentations, across PsA, nr-axSpA, and AS, as well as plaque psoriasis (PSO) 

 

Atlanta, November 14, 2024 – 1:00 (EST) – UCB, a global biopharmaceutical company, today announced the presentation of new two-year data confirming a sustained clinical response for the IL-17A and IL-17F inhibitor BIMZELX® (bimekizumab-bkzx), in adults with active psoriatic arthritis (PsA) and those with active non-radiographic axial spondyloarthritis with objective signs of inflammation (nr-axSpA) and active ankylosing spondylitis (AS). These results are the latest from the Phase 3 studies BE OPTIMAL (PsA), BE COMPLETE (PsA), and their open-label extension BE VITAL, as well as BE MOBILE 1 (nr-axSpA), BE MOBILE 2 (AS), and their open-label extension BE MOVING.1,2,3

Additionally, new one-year data demonstrated significant reduction in inflammation and structural lesions in nr-axSpA and AS, as assessed by magnetic resonance imaging (MRI), while two-year data confirmed minimal spinal radiographic progression in nr-axSpA and AS.4,5 These findings will be highlighted in oral presentations at the American College of Rheumatology (ACR) Convergence 2024, in Washington D.C., November 14–19.4,5

BIMZELX received FDA approval for PsA, nr-axSpA, and AS indications in September this year. The research presented at ACR demonstrates the long-term efficacy of BIMZELX, building on the breadth and depth of available data and reinforcing UCB’s continued commitment to people living with rheumatic diseases.6,7,8,9

“A major challenge for practicing rheumatologists is that existing treatments may lose efficacy over time, leaving patients vulnerable to debilitating symptoms. The new results presented at ACR Convergence 2024 show that bimekizumab-bkzx met stringent clinical endpoints, with high levels of efficacy across multiple domains of axial spondyloarthritis and psoriatic arthritis, and were sustained for two years, demonstrating bimekizumab-bkzx’s ability to remain effective over the long term,” said Dr Fabian Proft, Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Germany. 

“These new two-year data, revealing high levels of response, offer exciting insights into bimekizumab-bkzx’s sustained efficacy in non-radiographic axial spondyloarthritis, ankylosing spondylitis, and psoriatic arthritis,” said Fiona du Monceau, Head of Patient Evidence, UCB. “The results reinforce the potential of bimekizumab-bkzx as an effective approach to targeting key inflammatory pathways involved in PsA, nr-axSpA, and AS through dual inhibition of IL-17A and IL-17F, reflecting our ambition to provide differentiated treatments for people living with chronic inflammatory diseases.”

For people living with psoriatic arthritis, the new data demonstrated robust maintenance of clinical responses, including complete skin clearance (PASI100), minimal disease activity, improvements in joint pain, and patient reported outcomes to two years.1,2 More than 7 in 10 of Week 16 responders sustained a 50% improvement in ACR response criteria (ACR50) at two years.1* Maintenance of response was consistent regardless of whether patients were biologic disease-modifying anti-rheumatic drug-naïve (bDMARD-naïve: BE OPTIMAL), or had a previous inadequate response or intolerance to tumor necrosis factor inhibitors (TNFi-IR: BE COMPLETE).1*

For people living with nr-axSpA and AS, the two-year data demonstrated sustained, high levels of efficacy across all domains of axSpA and long-term maintenance of low disease activity and remission.3,4 More than 8 in 10 patients who achieved ASAS40 at Week 16 sustained this response at two years.3** 

New one-year data demonstrated that a higher proportion of patients with nr-axSpA or AS treated with BIMZELX achieved remission when defined by objective signs of inflammation (OSI) compared to ASDAS-Inactive Disease (ASDAS-ID).10 Remission based on OSI was defined as MRI remission in the sacroiliac joints and spine, normalization of C-reactive protein (CRP) levels, and resolution of swollen joints (see “Notes to Editors”).10† These findings highlight a potential need for optimized endpoints to guide clinical treatment management in axSpA.10† 

A two pooled safety analysis, each comprising three Phase 2b/3 studies and their open-label extensions, in patients with active nr-axSpA, AS, and active PsA confirmed that the long-term safety profile was consistent with previous studies.11

* Non-responder imputation
** Multiple imputation
†Observed case


Notes to Editors:
BIMZELX two-year data in PsA presented at ACR Convergence 2024: 
 
  • ACR50: Of patients who experienced ≥50% improvement from baseline in American College of Rheumatology response criteria (ACR50) at Week 16 (43.9% of 189 patients in BE OPTIMAL and 43.1% of 115 patients in BE COMPLETE), 79.4% of 150 bDMARD-naïve patients and 75.7% of 87 TNFi-IR patients maintained response to two years (Week 104/100 respectively).1* 
  • PASI100: Complete skin clearance (Psoriasis Area and Severity Index [PASI]100) experienced at Week 16 in patients with baseline psoriasis affecting ≥3% body surface area (47.5% of 103 patients in BE OPTIMAL and 58.5% of 103 patients in BE COMPLETE) was maintained to two years by 70.9% of 73 bDMARD-naïve patients in BE OPTIMAL and 80.6% of 83 TNFi-IR patients in BE COMPLETE.1* 
  • MDA: Similar trends were seen for minimal disease activity (MDA) response. Of those who experienced MDA at Week 16 (45.0% of 194 patients in BE OPTIMAL and 43.8% of 117 patients in BE COMPLETE), 75.8% of 147 bDMARD-naïve patients and 74.4% of 87 TNFi-IR patients maintained response to two years.1* 
  • Pain: Improvements in pain at one year were sustained up to two years, with approximately half of patients in all treatment groups experiencing a ≥50% reduction in Pain Visual Analog Scale (Pain VAS) at two years.2* 
  • Fatigue: Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue subscale (FACIT-Fatigue). Minimal clinically important difference (MCID) in FACIT-Fatigue scores (as defined by ≥4-point increase from baseline in patients with FACIT-Fatigue ≤48 at baseline) was achieved by nearly 5 in 10 patients in both BE OPTIMAL and BE COMPLETE with results sustained from Week 52.2*
BIMZELX two-year data in nr-axSpA and AS presented at ACR Convergence 2024: 
 
  • ASAS40: Of patients who achieved an Assessment of SpondyloArthritis international Society 40% improvement (ASAS40) at Week 16 (45.8% of 349 patients), 85.7% of 160 patients maintained this response over two years (Week 104).3** 
  • Low Disease Activity: Of patients who achieved Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity (LDA <2.1) at Week 16 (43.6% of 349 patients), 89.3% of 152 patients maintained the response to two years.3**
  • Inactive disease and remission: Of patients who reached ASDAS inactive disease (ASDAS <1.3) at Week 16 (16.6% of 349 patients), 76.0% of 58 patients maintained the response to two years.3** 
  • Resolution of objective signs of inflammation: More than 50% of patients with nr-axSpA and AS treated with BIMZELX achieved remission defined by the resolution of objective signs of inflammation (MRI of the sacroiliac joints and spine (SPARCC score <2), low C-reactive protein levels (≤5 mg/L), and a swollen joint count (SJC) of 0) at 52 weeks.10† Among placebo-randomized patients who switched to BIMZELX at 16 weeks, 35% of patients with nr-axSpA and 50% of patients with AS achieved remission defined by the resolution of objective signs of inflammation.10†
BIMZELX in PsA, nr-axSpA, and AS presented at ACR Convergence 2024: 
 
  • Low uveitis rates: In a pooling of the safety data from three BIMZELX studies in nr-axSpA and AS and their open-label extensions, 15.3% of 848 nr-axSpA and AS patients had a history of uveitis.11 Uveitis occurred in 3.7% of 848 patients, with a higher rate in those with a history of uveitis (13.8% of 130 patients) compared to those without (1.8% of 718 patients).11
  • Safety profile: In a pooling of the total safety data from six BIMZELX studies and their open-label extensions in PsA, nr-axSpA, and AS, the three most frequently reported treatment-emergent adverse events after 2 years (≥6% of patients in both the nr-axSpA and AS and PsA pools) were: SARS-CoV-2 (COVID-19) infection (20.9%), nasopharyngitis (15.7%), and upper respiratory tract infection (13.6%).11 After an additional year of exposure, the long-term safety profile of BIMZELX was consistent with previous studies.

 

* Non-responder imputation
†Observed case 
** Multiple imputation
 

About Psoriatic Arthritis

Psoriatic arthritis (PsA) is a serious, highly heterogeneous, chronic, systemic inflammatory condition affecting both the joints and skin with a prevalence of 0.02 percent to 0.25 percent of the population.  PsA affects approximately 30 percent of people living with psoriasis.  Symptoms include joint pain and stiffness, skin plaques, swollen toes and fingers (dactylitis), and inflammation of the sites where tendons or ligaments insert into the bone (enthesitis).14 The burden on those living with PsA extends beyond physical discomfort to reduced quality of life, with co-morbidities including hypertension, cardiovascular disease, anxiety, and depression.12 

About BE OPTIMAL and BE COMPLETE 

BE OPTIMAL and BE COMPLETE were two Phase 3 studies evaluating the efficacy and safety of BIMZELX in the treatment of psoriatic arthritis.1,2 The primary endpoint in both studies was the proportion of patients reaching 50% or greater improvement in American College of Rheumatology criteria (ACR50) at Week 16 (non-responder imputation).1,2 BE OPTIMAL (bDMARD-naïve) and BE COMPLETE (TNFi IR) assessed subcutaneous BIMZELX 160 mg every four weeks (Q4W) in patients with PsA; both studies were placebo-controlled to Week 16, after which placebo patients switched to BIMZELX.15,16

BE OPTIMAL included a reference arm (adalimumab 40 mg Q2W); adalimumab patients switched to BIMZELX at Week 52 with no washout between treatments.17 BE OPTIMAL Week 52 and BE COMPLETE Week 16 completers were eligible for BE VITAL open-label extension.17 From BE OPTIMAL 83.3 percent of patients (n=710/852) and from BE COMPLETE 80.5 percent (n=322/400) completed Week 104 and Week 100, respectively.17 Outcomes are reported for patients who completed to Week 100 of BE COMPLETE (not including 2 ongoing patients).17


About Axial Spondyloarthritis

Axial spondyloarthritis (axSpA), which includes both non-radiographic axSpA (nr-axSpA) and ankylosing spondylitis (AS), is a chronic, immune-mediated, inflammatory disease.18 nr-axSpA is defined clinically by the absence of definitive x-ray evidence of structural damage to the sacroiliac joints.18 axSpA is a painful condition that primarily affects the spine and the joints linking the pelvis and lower spine (sacroiliac joints).18 The leading symptom of axSpA in a majority of patients is inflammatory back pain that improves with exercise, but not with rest.18 Other common clinical features frequently include anterior uveitis, enthesitis, peripheral arthritis, psoriasis, inflammatory bowel disease, and dactylitis.18 The overall prevalence of axSpA is 0.3 percent to 1.4 percent of adults.19,20 Approximately half of all patients with axSpA are patients with nr-axSpA.18 axSpA onset usually occurs before the age of 45.18 Approximately 10 to 40 percent of patients with nr-axSpA progress to ankylosing spondylitis over two to 10 years.18 

About BE MOBILE 1 and BE MOBILE 2 

BE MOBILE 1 and BE MOBILE 2 were two Phase 3 studies evaluating the efficacy and safety of BIMZELX in the treatment of nr-axSpA and AS, respectively.9 The primary endpoint in both studies was Assessment of SpondyloArthritis international Society 40 percent (ASAS40) response at Week 16.9 BE MOBILE 1 and BE MOBILE 2 comprised a 16-week double-blind treatment period followed by a 36-week maintenance period.9 In BE MOBILE 1 and BE MOBILE 2, patients were randomized to BIMZELX (160 mg Q4W; N=128 for BE MOBILE 1 and N=221 for BE MOBILE 2) or to placebo (N=126 for BE MOBILE 1 and N=111 for BE MOBILE 2).9 Patients initially randomized to placebo were switched to BIMZELX (160 mg Q4W) at Week 16.9 At Week 52, those who completed either study were eligible to be enrolled into BE MOVING.3 Of 254 nr-axSpA patients and 332 AS patients originally randomized to BIMZELX or placebo in BE MOBILE 1 and 2, respectively, 494 patients entered BE MOVING at Week 52.3 

About BIMZELX (bimekizumab-bkzx)                                                                                        

BIMZELX is a humanized monoclonal IgG1 antibody that is designed to selectively inhibit both interleukin 17A (IL-17A) and interleukin 17F (IL-17F), two key cytokines driving inflammatory processes.21 Elevated levels of IL-17A and IL-17F are found in lesional psoriatic skin.21

The approved indications for BIMZELX in the U.S. are:21 
 

  • Plaque psoriasis: BIMZELX is approved for the treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy 
  • Psoriatic arthritis: BIMZELX is indicated for the treatment of adult patients with active psoriatic arthritis 
  • Non-radiographic axial spondyloarthritis: BIMZELX is indicated for the treatment of adult patients with active non-radiographic axial spondyloarthritis with objective signs of inflammation
  • Ankylosing spondylitis: BIMZELX is indicated for the treatment of adult patients with active ankylosing spondylitis

Please see Important Safety Information below and full U.S. prescribing information at www.UCB-USA.com/Innovation/Products/BIMZELX and www.BIMZELX.com.


BIMZELX U.S. IMPORTANT SAFETY INFORMATION

IMPORTANT SAFETY INFORMATION

Suicidal Ideation and Behavior
BIMZELX (bimekizumab-bkzx) may increase the risk of suicidal ideation and behavior (SI/B). A causal association between treatment with BIMZELX and increased risk of SI/B has not been established. Prescribers should weigh the potential risks and benefits before using BIMZELX in patients with a history of severe depression or SI/B. Advise monitoring for the emergence or worsening of depression, suicidal ideation, or other mood changes. If such changes occur, advise to promptly seek medical attention, refer to a mental health professional as appropriate, and re-evaluate the risks and benefits of continuing treatment. 

Infections
BIMZELX may increase the risk of infections. Do not initiate treatment with BIMZELX in patients with any clinically important active infection until the infection resolves or is adequately treated. In patients with a chronic infection or a history of recurrent infection, consider the risks and benefits prior to prescribing BIMZELX. Instruct patients to seek medical advice if signs or symptoms suggestive of clinically important infection occur. If a patient develops such an infection or is not responding to standard therapy, monitor the patient closely and do not administer BIMZELX until the infection resolves.

Tuberculosis
Evaluate patients for tuberculosis (TB) infection prior to initiating treatment with BIMZELX. Avoid the use of BIMZELX in patients with active TB infection. Initiate treatment of latent TB prior to administering BIMZELX. Consider anti-TB therapy prior to initiation of BIMZELX in patients with a past history of latent or active TB in whom an adequate course of treatment cannot be confirmed. Closely monitor patients for signs and symptoms of active TB during and after treatment.

Liver Biochemical Abnormalities
Elevated serum transaminases were reported in clinical trials with BIMZELX. Test liver enzymes, alkaline phosphatase, and bilirubin at baseline, periodically during treatment with BIMZELX and according to routine patient management. If treatment-related increases in liver enzymes occur and drug-induced liver injury is suspected, interrupt BIMZELX until a diagnosis of liver injury is excluded. Permanently discontinue use of BIMZELX in patients with causally associated combined elevations of transaminases and bilirubin. Avoid use of BIMZELX in patients with acute liver disease or cirrhosis. 

Inflammatory Bowel Disease
Cases of inflammatory bowel disease (IBD) have been reported in patients treated with IL-17 inhibitors, including BIMZELX. Avoid use of BIMZELX in patients with active IBD. During BIMZELX treatment, monitor patients for signs and symptoms of IBD and discontinue treatment if new onset or worsening of signs and symptoms occurs.  

Immunizations
Prior to initiating therapy with BIMZELX, complete all age-appropriate vaccinations according to current immunization guidelines. Avoid the use of live vaccines in patients treated with BIMZELX.  

Most Common Adverse Reactions
Most common (≥ 1%) adverse reactions in plaque psoriasis include upper respiratory tract infections, oral candidiasis, headache, injection site reactions, tinea infections, gastroenteritis, Herpes Simplex infections, acne, folliculitis, other candida infections, and fatigue.

Most common (≥ 2%) adverse reactions in psoriatic arthritis include upper respiratory tract infections, oral candidiasis, headache, diarrhea, and urinary tract infection.

Most common (≥ 2%) adverse reactions in non-radiographic axial spondyloarthritis include upper respiratory tract infections, oral candidiasis, headache, diarrhea, cough, fatigue, musculoskeletal pain, myalgia, tonsillitis, transaminase increase, and urinary tract infection.

Most common (≥ 2%) adverse reactions in ankylosing spondylitis include upper respiratory tract infections, oral candidiasis, headache, diarrhea, injection site pain, rash, and vulvovaginal mycotic infection.

 

For further information, contact UCB:

Investor Relations
Antje Witte
T +32.2.559.94.14 
email antje.witte@ucb.com

Brand Communications
Nicole Herga
T +1.773.960.5349
email nicole.herga@ucb.com



About UCB 

UCB, Brussels, Belgium (www.ucb.com) is a global biopharmaceutical company focused on the discovery and development of innovative medicines and solutions to transform the lives of people living with severe diseases of the immune system or of the central nervous system. With approximately 9,000 people in approximately 40 countries, the company generated revenue of €5.3 billion in 2023. UCB is listed on Euronext Brussels (symbol: UCB). Follow us on Twitter: @UCBUSA.

Forward looking statements 

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these uncertainties, you should not place undue reliance on any of such forward-looking statements. There can be no guarantee that the investigational or approved products described in this press release will be submitted or approved for sale or for any additional indications or labelling in any market, or at any particular time, nor can there be any guarantee that such products will be or will continue to be commercially successful in the future.

UCB is providing this information, including forward-looking statements, only as of the date of this press release. UCB expressly disclaims any duty to update any information contained in this press release, either to confirm the actual results or to report or reflect any change in its forward-looking statements with regard thereto or any change in events, conditions or circumstances on which any such statement is based, unless such statement is required pursuant to applicable laws and regulations. 

Additionally, information contained in this document shall not constitute an offer to sell or the solicitation of an offer to buy any securities, nor shall there be any offer, solicitation or sale of securities in any jurisdiction in which such offer, solicitation or sale would be unlawful prior to the registration or qualification under the securities laws of such jurisdiction.




References
 

  1. Walsh JA, Merola JF, Ritchlin CT, et al. Bimekizumab maintained efficacy responses in patients with active psoriatic arthritis: up to 2-year results from two Phase 3 studies. Abstract presented at ACR Convergence 2024. Washington D.C. November 2024. 
  2. Mease PJ, Tillett W, de Wit M, et al. Bimekizumab-treated patients with active psoriatic arthritis showed sustained improvements in pain and fatigue: up to 2-year results from two phase 3 studies. Abstract presented at ACR Convergence 2024. Washington D.C. November 2024.
  3.  Proft F, van der Heijde D, Schwartzman S, et al. Bimekizumab maintained stringent clinical responses over 2 years in patients with axial spondyloarthritis: results from two phase 3 studies. Abstract presented at ACR Convergence 2024. Washington D.C. November 2024. 
  4. Maksymowych W, Ramiro S, Poddubnyy D, et al. Bimekizumab treatment resulted in improvements in MRI inflammatory and structural lesions in the sacroiliac joints of patients with axial spondyloarthritis: 52-week results and post hoc analyses from two phase 3 studies. Abstract presented at ACR Convergence 2024. Washington D.C. November 2024.
  5. Baraliakos X, Ramiro S, Maksymowych W, et al. Minimal spinal radiographic progression in patients with radiographic axial spondyloarthritis over 2 years of bimekizumab treatment: Results from a phase 3 open-label extension study. Abstract presented at ACR Convergence 2024. Washington D.C. November 2024.
  6. McInnes IB, Asahina A, Coates LC, et al. Bimekizumab in patients with psoriatic arthritis, naïve to biologic treatment: a randomised, double-blind, placebo-controlled, phase 3 trial (BE OPTIMAL). Lancet. 2023;401(10370):25–37.
  7. Merola JF, Landewé R, McInnes IB, et al. Bimekizumab in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α inhibitors: a randomised, double-blind, placebo-controlled, phase 3 trial (BE COMPLETE). Lancet. 2023;401(10370):38–48.
  8. van der Heijde D, Deodhar A, Baraliakos X, et al. Efficacy and safety of bimekizumab in axial spondyloarthritis: results of two parallel phase 3 randomized controlled trials. Ann Rheum Dis. 2023;82:515–26.
  9.  Baraliakos X, Deodhar A, van der Heijde D, et al. Bimekizumab treatment in patients with active axial spondyloarthritis: 52-week efficacy and safety from the randomised parallel phase 3 BE MOBILE 1 and BE MOBILE 2 studies. Ann Rheum Dis. 2024;83(2):199–213.
  10. Gensler L, Marzo-Ortega H, Taieb V, et al. Achievement of remission defined by absence of objective signs of inflammation vs ASDAS ID in patients with active axial spondyloarthritis treated with bimekizumab: 52-week results from two phase 3 studies. Abstract presented at ACR Convergence 2024. Washington D.C. November 2024.
  11. Mease P, Poddubnyy D, Bajracharya R, et al. Updated Long-term safety and tolerability of bimekizumab in patients with axial spondyloarthritis and psoriatic arthritis: pooled results from phase 2b/3 studies. Abstract presented at ACR Convergence 2024. Washington D.C. November 2024.
  12. Ogdie A, Weiss P. The Epidemiology of Psoriatic Arthritis. Rheum Dis Clin North Am. 2015;41(4):545–68.
  13. Mease PJ, Gladman DD, Papp KA, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2013;69(5):729-735. doi: 10.1016/j.jaad.2013.07.023.
  14. Mease PJ, Armstrong AW. Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs. 2014;74:423–41.
  15. Ritchlin CT, Coates LC, McInnes IB, et al. Bimekizumab treatment in biologic DMARD-naïve patients with active psoriatic arthritis: 52-week efficacy and safety results from the phase III, randomised, placebo-controlled, active reference BE OPTIMAL study. Ann Rheum Dis. 2023;82:1404–14.
  16. Coates LC, Landewé R, McInnes IB, et al. Bimekizumab treatment in patients with active psoriatic arthritis and prior inadequate response to tumour necrosis factor inhibitors: 52-week safety and efficacy from the phase III BE COMPLETE study and its open-label extension BE VITAL. RMD Open. 2024;10:e003855. doi:10.1136/rmdopen-2023-003855 
  17. Coates L, Kristensen L, Ogdie A, et al. Bimekizumab-treated patients with active psoriatic arthritis showed sustained achievement of minimal disease activity and remission: up to 2-year results from two phase 3 studies. Abstract at EULAR 2024, Vienna, Austria.
  18. Deodhar A. Understanding Axial Spondyloarthritis: A Primer for Managed Care. Am J Manag Care. 2019;25:S319–30.
  19. Reveille JD, Witter JP, Weisman MH. Prevalence of axial spondylarthritis in the United States: estimates from a cross-sectional survey. Arthritis Care Res (Hoboken). 2012;64(6):905–10.
  20. Hamilton L, Macgregor A, Toms A, et al. The prevalence of axial spondyloarthritis in the UK: a cross-sectional cohort study. BMC Musculoskelet Disord. 2015;21;16:392.
  21.  BIMZELX® (bimekizumab-bkzx) U.S. Prescribing Information. https://www.ucb-usa.com/Innovation/Products/BIMZELX. Accessed November 2024.