Interleukin-23 Blocker Risankizumab Promising for Psoriasis

Psoriasis illustration
Psoriasis illustration
In this first report of a head-to-head trial comparing risankizumab and adalimumab, the former agent was found to demonstrate greater efficacy in patients with moderate to severe plaque psoriasis.

The interleukin-23 (IL-23) blocker risankizumab was found to be highly effective and demonstrated significantly greater efficacy than adalimumab for patients with moderate to severe plaque psoriasis, according to study results in The Lancet. Risankizumab showed similar adverse events compared with adalimumab, and no safety concerns were noted.

Part A of the multicenter trial (IMMvent; Identifier: NCT02672852) was a 16-week treatment period that included 605 patients aged 18 years or older with moderate to severe chronic plaque psoriasis. Patients were randomly assigned to receive either risankizumab 150 mg subcutaneously at weeks 0 and 4 (n=301) or adalimumab 80 mg subcutaneously at trial randomization (n=304) and 40 mg every other week from week 1 until the end of week 15. Nearly all patients (n=294, 98%) in the risankizumab group and 291 patients (96%) in the adalimumab group completed part A of the trial.

At week 16, PASI 90 was achieved by 72% (n=218) of 301 participants treated with risankizumab compared with 47% (n=144) of 304 participants in the adalimumab group (95% CI, 17.5-32.4; P <.0001); all participants had a PASI of 12 or higher at study commencement. Additionally, at week 16, 40% (n=120) of participants treated with risankizumab achieved PASI 100 compared with 23% (n=70) participants in the adalimumab group.

In part B of the study, which continued through week 44, the 53 participants in the adalimumab group who did not achieve PASI 90 were randomly assigned to risankizumab at week 16. Of these patients, 66% (n=35) achieved PASI 90 and 40% (n=21) achieved PASI 100 at week 44. Adverse events were similar between both groups, and there were no safety concerns reported.

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“The results reported by Reich and colleagues give us another highly effective, convenient therapy that will help many patients with psoriasis despite the many comorbidities and other factors we have to consider when selecting the optimal therapy,” wrote Mark Lebwohl, in an accompanying Comment in The Lancet.

A limitation of the study is the prolonged interval between final dose and final assessment: final adalimumab assessment occurred 3 weeks after the last dose and final risankizumab assessment was conducted 12 to 16 weeks after the last dose. This interval may have resulted in a small tapering of PASI responses at week 44 compared with week 40.

For patients who do not respond adequately to adalimumab, the investigators wrote, the data support that they “can be switched to risankizumab after 16 weeks without undergoing a washout period and that this switch might result in improved efficacy with no additional safety risk.”

Disclosure: Several study authors and Dr Lebwohl declared affiliations with the pharmaceutical industry. Please see the original references for a full list of authors’ disclosures.

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  1. Reich K, Gooderham M, Thaçi D, et al. Risankizumab compared with adalimumab in patients with moderate-to-severe plaque psoriasis (IMMvent): a randomised, double-blind, active-comparator-controlled phase 3 trial [published online July 4, 2019]. Lancet. Doi: 10.1016/S0140-6736(19)30952-3
  2. Lebwohl M. Interleukin-23 blockade: another breakthrough in the treatment of psoriasis [published online July 4, 2019]. Lancet. doi: 10.1016/S0140-6736(19)31513-2