Efficacy of Risankizumab For Severe Psoriasis

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A recent study is showing promising results for patients with severe psoriasis with the use of risankizumab (Skyrizi; AbbVie). Not only did the study confirm the efficacy of the drug, but researchers wrote that it showed success with the involvement of difficult to treat areas and first-time biologic users.¹

While mild cases of psoriasis are typically managed with topical prescription therapy, the researchers behind this study aimed to observe the use of systemic treatment specifically the IL-23 inhibitor risankizumab, in patients with higher disease severity.

Risankizumab is the latest IL inhibitor licensed for treating plaque psoriasis, psoriatic arthritis and Chron’s disease. It was observed to be effective and safe in clinical trials,² and confirmed by a real-life study in Italy.³ This study corroborated these results in patients with higher severity over a 2-year period and compared results of patients naive to biologics to those with previous experience.

Results

The investigators found the mean psoriasis area and severity index (PASI) score was reduced since week 16 and the mean improvement was maintained at all check in points (weeks 16, 28, 40 and 104). An improvement of up to PASI 75 was reached by all participants by week 40 and maintained at week 104. By week 104, 21 out of 21 patients reached PASI 90. After 2 years of treatment, the researchers found that 17 of 21 patients reached PASI 100.

Each patient had at least 1 difficult to treat area, which was evaluated by a site-specific psoriasis global assessment (PGA) of clear, almost clear, moderate, severe and very severe. By week 40, 22 of 23 patients had a clear scalp and by week 104, 20 of 21 patients had the same result. One patient with moderate palmoplantar psoriasis at baseline was clear at week 16, and 2 patients with mild palmoplantar psoriasis at baseline were clear by week 28. Four patients who had severe psoriasis in the genital area were all clear by week 16, and 3 with mild psoriasis of nails found it was absent by week 40. The researchers noted that moderate nail involvement was observed.

Impact of Previous Biologics

The mean PASI at baseline for all patients included (n = 27) was 35.1 ± 5.1. Before this study, 8 participants had not received systemic therapy before, while the other 19 attempted one or more systemic treatments. Sixteen were new to biologics and 3 had received one or more but discontinued due to loss of efficacy.

According to the researchers behind this study, from week 16 on patients with previous biologic experience had higher mean PASI than naive patients. Improvement of PASI was observed to be higher in naive than in non-naive subjects. PASI 75 was found to be reached more frequently by naive subjects at week 16 and PASI 90 was more frequent at weeks 16 and 28. At all visits, researchers found PASI 100 was obtained more frequently by naive subjects than those who previously received biologic treatment.

“Our data suggest that risankizumab may be effectively used in patients with very severe plaque psoriasis and that it may obtain better results if used before other biologics,” the researchers wrote.

Unlike their experiences with other biologics, no patients discontinued risankizumab due to adverse events.

For patients who skipped scheduled visits, skipped a dose or did the injection of risankisumab at home, data from the last available visit was used.

References

1. Orsini, D., Assorgi, C., Bonifati, C., et al. Effectiveness and safety of risankizumab in very severe plaque psoriasis: a real-life retrospective study (VESPA-Study). J Dermatolog Treat. 2024;35(1). https://doi.org/10.1080/09546634.2024.2358150
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 two 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. Orsini D, Gargiulo L, Ibba L, et al. Effectiveness of risankizumab in plaque psoriasis with involvement of difficult-to-treat areas: a real-world experience from two referral centers. J Dermatolog Treat. 2023;34(1):2220849. doi:10.1080/09546634.2023.2220849