Comparing Effectiveness of Risankizumab and Deucravacitinib in Plaque Psoriasis

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In recent years, novel therapies have been introduced to treat plaque psoriasis (PsO), including deucravacitinib, an oral tyrosine kinase (TYK) 2 inhibitor, and risankizumab, a subcutaneous interleukin (IL)-23 inhibitor. Because of this, a study employed a matching-adjusted indirect comparison (MAIC) to evaluate the efficacy of these treatments in moderate to severe PsO. Data from 4 phase 3 trials were analyzed. Researchers found risankizumab demonstrated superior outcomes in skin clearance (PASI and sPGA scores) and health-related quality of life (HRQoL) (DLQI scores) compared to deucravacitinib. They stated the findings suggest risankizumab may offer greater efficacy for patients with moderate to severe PsO.¹

“At 16 weeks, risankizumab-treated patients demonstrated statistically significantly higher rates of skin clearance and greater improvement in QoL compared to those treated with deucravacitinib,” researchers wrote. “Across all outcomes, risankizumab demonstrated a lower number needed to treat compared to deucravacitinib.”

Study Methods

The MAIC included data from 2 risankizumab trials (UltIMMa-1 and UltIMMa-2) and 2 deucravacitinib trials (POETYK PSO-1 and POETYK PSO-2).^2-3 Patients were ≥18 years, had moderate to severe PsO for ≥6 months, and were candidates for systemic therapy. Moderate to severe PsO was defined as body surface area (BSA) ≥10%, Static Physician’s Global Assessment (sPGA) ≥3, and Psoriasis Area and Severity Index (PASI) ≥12.

Individual patient data from risankizumab trials were weighted to match published summary data from deucravacitinib trials. Outcomes were evaluated at 16 and 52 weeks, including PASI 75/90/100, sPGA 0/1, and DLQI 0/1. Rate differences and numbers needed to treat (NNTs) were calculated using SAS and RStudio software.

According to the study, approximately 35% of patients included had prior exposure to biologic therapy. Most (78.9% to 81.9%) had a sPGA score of 3, with a mean PASI score of roughly 21, a mean % BSA of 25.3% to 26.4%, and a mean DLQI score of roughly 12. Although up to 20% of patients included in the study had psoriatic arthritis, scalp and nail PsO were excluded from the effect modifiers due to a skewed distribution during the matching process.

Results

The matched cohort included 598 risankizumab-treated and 843 deucravacitinib-treated patients. Baseline demographics, including age, sex, and prior biologic exposure, were balanced post-matching.

The study found risankizumab demonstrated significantly higher efficacy than deucravacitinib. Researchers reported proportions of patients achieving PASI 75/90/100 were 90.9%, 76.8%, and 44.2%, respectively, for risankizumab, compared to 55.2%, 30.4%, and 11.7% for deucravacitinib. Corresponding NNTs reportedly favored risankizumab. The study stated HRQoL improvements (DLQI 0/1) were also greater in the risankizumab cohort (70.6% vs. 37.7%).

At 52 weeks, researchers found risankizumab maintained superior effectiveness, with 91.8% achieving PASI 75 versus 65.1% for deucravacitinib. They stated similar trends were observed for sPGA 0/1 outcomes.

This study demonstrates that risankizumab provides greater efficacy in skin clearance and HRQoL improvements compared to deucravacitinib in moderatetosevere PsO. MAIC methodology minimizes bias by matching patient populations, offering robust insights in the absence of direct head-to-head trials. Researchersstated limitations include potential confounding from unmeasured variables and restricted generalizability to real-world settings.

Conclusions

The study found risankizumab demonstrated superior effectiveness in treating moderate to severe PsO compared to deucravacitinib. Researchers stated these findings can inform clinical decision-making, writing, “the results of this study may help inform health care providers in their treatment decision making for bio-naïve and bio-experienced patients with PsO.” They suggested future research should explore long-term real-world outcomes and head-to-head trials to validate these findings.

References

1. Armstrong AW, Soliman AM, Gisondi P, et al. Matching-adjusted indirect comparison of risankizumab versus deucravacitinib in patients with moderate to severe plaque psoriasis. Dermatol Ther (Heidelb). 2024;14(11):3071-3081. doi:10.1007/s13555-024-01293-y
2. Gordon KB, Strober B, Lebwohl M, et al. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from 2 double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. Lancet. 2018;392(10148):650-661. doi:10.1016/S0140-6736(18)31713-6
3. Armstrong AW, Augustin M, Beaumont JL, et al. Deucravacitinib improves patient-reported outcomes in patients with moderate to severe psoriasis: Results from the phase 3 randomized POETYK PSO-1 and PSO-2 trials. Dermatol Ther (Heidelb). 2024;14(8):2235-2248. doi:10.1007/s13555-024-01224-x