Risankizumab versus Ustekinumab for Moderate-to-Severe Plaque Psoriasis

Area of Science:

• Immunodermatology
• Biologics in Dermatology
• Psoriasis Pathogenesis

Background:

• Interleukin-23 (IL-23) plays a key role in the development of psoriasis.
• Psoriasis is a chronic inflammatory skin condition requiring effective treatments.
• Targeting IL-23 is a promising therapeutic strategy for psoriasis.

Purpose of the Study:

• To compare the efficacy of risankizumab, an IL-23 specific inhibitor, against ustekinumab, an IL-12/IL-23 inhibitor.
• To evaluate clinical responses in patients with moderate-to-severe plaque psoriasis treated with risankizumab or ustekinumab.

Main Methods:

• A randomized trial involving 166 patients with moderate-to-severe plaque psoriasis.
• Patients received subcutaneous risankizumab (18 mg, 90 mg, or 180 mg) or ustekinumab (45 mg or 90 mg).
• The primary endpoint was a 90% reduction in Psoriasis Area and Severity Index (PASI) score at week 12.

Main Results:

• 77% of patients on pooled risankizumab doses (90 mg and 180 mg) achieved >=90% PASI reduction at week 12, versus 40% for ustekinumab (P<0.001).
• 45% of patients on pooled risankizumab achieved 100% PASI reduction, compared to 18% for ustekinumab.
• Efficacy was maintained up to 20 weeks post-treatment; safety data was limited due to trial size and duration.

Conclusions:

• Selective IL-23 blockade with risankizumab showed superior clinical responses compared to ustekinumab in this Phase 2 trial.
• Risankizumab represents a potentially more effective targeted therapy for moderate-to-severe plaque psoriasis.
• Further studies are needed to confirm long-term safety and efficacy.