Risankizumab Associated With Improved Skin Clearance vs Secukinumab in Moderate to Severe Psoriasis

Risankizumab may provide superior skin clearance vs secukinumab in the treatment of patients with moderate-to-severe psoriasis regardless of disease characteristics or weight, according to study findings published in Dermatology and Therapy.

In the treatment of psoriasis, efficacy of current biologic therapies was noted by the study authors to be affected by several compromising factors, such as comorbid obesity, prior biologic treatment failure, or a longer disease duration.

“Despite the availability of current therapies to treat moderate-to-severe psoriasis, there remains a need for efficacious treatments that provide long-term clinical benefit in a variety of patients, including those who are difficult to treat, regardless of patient demographics and disease characteristics,” they added.

In findings of the global, phase 3, multicenter, randomized, open-label, efficacy-assessor-blinded, active-comparator IMMerge study, risankizumab, a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin (IL)-23 by binding its p19 subunit, was shown to be non-inferior to secukinumab at week 16 and superior at week 52 in treating moderate-to-severe plaque psoriasis.

Researchers conducted post hoc analyses of the IMMerge study to investigate the applicability of these study findings across patient subgroups. In the analyses, the efficacy of risankizumab 150 mg vs secukinumab 300 mg among adults with moderate-to-severe psoriasis was evaluated across several endpoints:

• Proportion of patients who achieved Psoriasis Area and Severity Index (PASI) 90 (90% resolution of skin lesions) and the least-squares (LS) mean percent PASI improvement from baseline at week 52 by body weight and body mass index (BMI)
• PASI 90 by prior treatment
• Clinical response, including PASI 90, PASI 100, and/or static Physician’s Global Assessment (sPGA) score of clear (0) or almost clear (1) at week 16 and maintained particular response at week 52

Of the 327 patients with moderate-to-severe psoriasis randomized to receive risankizumab (n = 164) or secukinumab (n = 163), mean (SD) baseline PASI was 19.9 (7.2), mean (SD) patient age was 47.1 (14.1), mean (SD) weight was 91.5 (24.7) kg, 36.7% received prior biologic treatment for psoriasis, and the majority (84.7%) had a baseline sPGA score of 3.

Across all patient subgroups, a numerically greater proportion of patients treated with risankizumab achieved PASI 90 at week 52 than those treated with secukinumab (risankizumab, 74.1%-92.3%; secukinumab, 46.8%-65.0%).

Specific to each subgroup, PASI 90 was achieved by more patients at week 52 who were treated with risankizumab compared with patients receiving secukinumab, regardless of BMI (risankizumab, 84.6%-88.9%; secukinumab, 49.4%-64.9%; P < .05), body weight (risankizumab, 85.7%-88.5%; secukinumab, 44.4%-63.3%; P < 0.001), or weight quartiles (risankizumab, 78.0%-92.5%; secukinumab, 42.9%-66.7%; P < .05).

Moreover, improvements in PASI LS mean percent change from baseline at week 52 were statistically greater in patients taking risankizumab vs secukinumab, regardless of weight or BMI (risankizumab vs secukinumab; P < .05 for all).

After adjusting for important patient characteristics, logistic regression modeling further showed treatment type (risankizumab vs secukinumab) had a significant impact on the proportion of patients who achieved PASI 90 at week 52 (P < .0001).

“These data showed risankizumab is a durable treatment for plaque psoriasis across many patients, including those with greater body weight and those who have had less than adequate response to other biologics,” concluded the study authors.

Reference

Crowley JJ, Langley RG, Gordon KB, et al. Efficacy of risankizumab versus secukinumab in patients with moderate-to-severe psoriasis: Subgroup analysis from the IMMerge study. Dermatol Ther (Heidelb). Published online January 20, 2022. doi:10.1007/s13555-021-00679-6