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Risankizumab demonstrated long-term efficacy in patients with psoriasis, showing durability through 256 weeks and against harder-to-treat disease manifestations.

A total of 525 patients with moderate-to-severe plaque psoriasis were randomized to risankizumab 150 mg during two double-blind, phase 3, 52-week base studies. Subgroup assessments included the proportion of patients who achieved 90-100% improvement according to the Psoriasis Area and Severity Index (PASI). Nail, scalp, or palmoplantar psoriasis was assessed based on changes from baseline and full resolution.

A similar proportion of patients achieved PASI 90/100 through week 256 regardless of age, sex, body mass index, weight, PASI, or psoriatic arthritis status. Patients with nail, scalp, or palmoplantar psoriasis experienced substantial improvements in manifestation-specific indices (>81%, >94% and >97% improvement, respectively, from baseline to week 256). In patients with all three manifestations (n=121), 44.6% achieved complete clearance.

The study report, which appears in the , was co-authored by a team of American, European, and Canadian researchers. The following excerpts have been edited for length and clarity.

What was the impetus for this investigation?

There are many treatment options available for psoriasis, but the efficacy of some therapies over time may vary according to baseline patient characteristics, including elevated body weight.

Risankizumab is approved for the treatment of moderate-to-severe plaque psoriasis in the U.S., European Union, and Japan. The drug previously demonstrated superior efficacy over placebo at week 16 and other psoriasis therapies at weeks 16-52.

The long-term efficacy of risankizumab according to baseline patient characteristics has not yet been reported beyond 52 weeks. In their report, researchers shared interim results from an open-label extension study evaluating the efficacy of risankizumab according to baseline patient characteristics as well as efficacy for nail, scalp and palmoplantar psoriasis, through nearly 5 years of continuous treatment.

What were the key findings?

The clinical response to risankizumab was generally consistent long term across all patient subgroups evaluated, including age, sex, weight and baseline disease severity. PASI 90 and PASI 100 response rates at week 256 were similar to those observed in the general study population. In other words, interactions between age, sex, body weight, and baseline disease severity did not significantly influence clinical outcomes.

What do these findings suggest about the connection between psoriasis, body weight/obesity, and risankizumab?

Obesity and metabolic syndrome are common comorbidities among people with psoriasis.

In a previous review of studies reporting efficacy of biologic psoriasis therapies by body weight or BMI, lower response rates were reported among patients with higher body weight or BMI. These differences were not observed in the current analysis; clinical response rates were generally comparable and durable in body weight and BMI subgroups through 256 weeks of treatment.

The reduced efficacy associated with obesity is variable across different biologic therapies. Further studies are needed to understand the underlying mechanisms.

What are the key take-home messages?

Risankizumab displayed high clinical response rates regardless of patient demographics and disease characteristics.

In particular, substantial clinical improvements were observed among patients with nail, scalp, and palmoplantar psoriasis. Most patients who had at least one of these conditions and almost half of those who had all three achieved complete clearance at week 256.

These findings demonstrate the ability of risankizumab to comprehensively address psoriatic symptoms, including difficult-to-treat manifestations in specialized areas, and highlight the versatility of treatment with this agent across a wide range of patient phenotypes.