Risankizumab shows best benefit-risk profile for psoriasis treatment over long term

Anti-interleukin 23 inhibitors showed the best short-term safety rates for the treatment of moderate to severe psoriasis, while risankizumab was best in the long term, according to a network meta-analysis.

“A number of biologics have been approved by the United States Food and Drug Administration and European Medicines Agency for the treatment of psoriasis, including tumor necrosis factor inhibitors (adalimumab, etanercept, infliximab and certolizumab), anti-interleukin (IL) 12/23 monoclonal antibodies (ustekinumab), anti-IL-17A agents (secukinumab, ixekizumab and brodalumab) and anti-IL-23 agents (risankizumab, tildrakizumab and guselkumab),” Neil H. Shear, MD, of the Sunnybrook Health Sciences Centre, University of Toronto, and colleagues wrote in the Journal of the American Academy of Dermatology. “Although biologic agents are generally safe and well tolerated, like any other medications, they are associated with adverse effects that may be related to their mechanism of action, dosing or other factors.”

The systematic literature review network meta-analysis evaluated 52 clinical trials for short-term safety and seven trials for long-term safety.

The lowest rates of any adverse events were recorded in patients taking tildrakizumab for 12 weeks at 200 mg (46%; 95% credible intervals, 39.2% to 52.9%) and 100 mg (46.3%; 95% CrI, 39.5% to 53.2%). Certolizumab every 2 weeks at 200 mg (46.2%; 95% CrI, 37% to 55.5%) and 400 mg (52.2%; 95% CrI, 43.3% to 61.1%); etanercept (49.1%; 95% CrI, 35.5% to 62.9%); risankizumab (52.4%; 95% CrI, 47.3% to 57.4%); and guselkumab (55.8%; 95% CrI, 50.9% to 60.3%) followed for short-term events.

Statistically significantly lower odds of any adverse events were recorded with tildrakizumab (100 mg every 12 weeks and 200 mg every 12 weeks), certolizumab (200 mg every two weeks) and risankizumab.

In the long term, the lowest rates of any adverse events (67.5%; 95% CrI, 57.8% to 75.6%), serious adverse events (4.4%; 95% CrI, 2.4% to 8.1%) and adverse events leading to treatment discontinuation (1%; 95% CrI, 0.2% to 4.1%) were recorded in patients taking risankizumab.

“This study suggested that the anti-IL-23 agents (eg, guselkumab, risankizumab and tildrakizumab) were associated with low rates of safety events in the short term, among which risankizumab and guselkumab also had favorable efficacy profiles,” the authors wrote. “In the long term, risankizumab was associated with the most favorable benefit-risk profile compared with the anti-IL-17 agents (ixekizumab and secukinumab), adalimumab and ustekinumab.”