Switching to risankizumab may improve treatment response in patients with psoriasis

Patients who had an “intermediate” response to adalimumab saw improvements to markers of psoriasis and quality of life after switching to risankizumab, according to results from a phase 3 trial presented at Maui Derm for Dermatologists.

“Interleukin 23 (IL-23), a heterodimer with two subunits (p19 and p40), is a key cytokine that activates T helper 17 cells, which promote the pathogenesis of psoriasis,” Jeffrey Crowley, MD, and colleagues wrote in the poster. “Risankizumab is a novel humanized immunoglobulin G1 monoclonal antibody that specifically inhibits IL-23 by binding with high affinity to the p19 subunit.”

Crowley and colleagues conducted an analysis of data from the IMMvent active-comparator-controlled phase 3 trial, which enrolled adults who had moderate to severe plaque psoriasis with or without psoriatic arthritis for at least 6 months, 10% or greater affected body surface area, Psoriasis Area and Severity Index scores of 12 or higher, and static Physician’s Global Assessment scores of 3 or higher. All patients were treated with adalimumab for 16 weeks.

Among 109 patients with intermediate response to adalimumab, researchers randomly reassigned 53 patients to treatment with risankizumab. Changes in PASI and Dermatology Life Quality Index scores were the primary outcomes.

Patients who were reassigned to risankizumab had PASI reductions from 4.7 at week 16 to 2.8 at week 20 (85.7% decrease from baseline), with 65.4% showing improved clinical response. At week 44, mean PASI scores among these patients decreased to 1.5 (92.9% decrease from baseline), with 79.2% having an improved clinical response.

Patients also saw improvements to DLQI scores after reassignment to risankizumab. The proportion of patients whose score indicated “no effect on quality of life” increased from 42% at week 16 to 68.6% at week 44. The proportion of patients who had a DLQI score reduction of 5 or more points increased from 87% at week 16 to 93.6% at week 44.

“Results from this analysis demonstrate that among patients with intermediate response to [adalimumab], switching to [risankizumab] was associated with improved efficacy and quality of life,” the researchers wrote. “In a clinical setting, these results support that switching to [risankizumab] can be efficacious in patients who show intermediate (suboptimal) responses to [adalimumab].”