Risankizumab After Guselkumab Failure as Effective as Risankizumab Alone

Patients with moderate to severe psoriasis who were treated with risankizumab after a guselkumab failure experienced a similar improvement to patients who were only treated with risankizumab, according to results of an observational study published in the British Journal of Dermatology.

Although studies have shown that in-class biologic agent switching can be effective in the treatment of psoriasis, the efficacy of an in-class IL-23 inhibitor switch has not yet been determined.

Data from 41 patients with moderate to severe psoriasis were analyzed by the investigators. In all, 23 patients (39% women; average age 45.0±15.4 years) were initially treated with 100mg of guselkumab and were later switched to 150mg of risankizumab. A total of 18 patients (39% women; average age 44.9±13.0 years) were naive to anti-IL-23 therapies and were treated with 150mg of risakinumab. Psoriasis severity was measured by multiplying the Physician’s Global Assessment by the affected body surface area (PGA*BSA).

Patients who had switched to risankizumab from guselkumab experienced a 79.3% average decrease in PGA*BSA after treatment. Patients who were naive to anti-IL-23 treatments experienced an 84.3% decrease in PGA*BSA after treatment.

Limitations to this study include its retrospective nature and small sample size. Future studies with larger sample sizes, and longer follow-up time are warranted.

The results of this study indicated to the researchers that patients who experienced a failed response to guselkumab and later switched to risankizumab had a similar response to those who had only ever received risankizumab.


Reddy R, Pannu S, Fiumara K, Khan J, Rosmarin D. Efficacy of in-class IL-23 inhibitor switching: Risankizumab following guselkumab failure in moderate-to-severe psoriasis treatment. [published online September 30, 2020]. Br J Dermatol. doi:10.1111/bjd.19575