Risankizumab Effective for Fingernail Psoriasis in Patients With Psoriatic Arthritis

Fingernail psoriasis
Left hand thumb with fingernail psoriasis. Psoriasis is an autoimmune disease.
The effectiveness of risankizumab (RZB) in treating fingernail psoriasis in patients with psoriatic arthritis is reported.

Risankizumab (RZB), an interleukin-23 inhibitor, was highly effective in treating fingernail psoriasis in patients with psoriatic arthritis, according to results from weeks 24 and 52 of KEEPsAKE 1, a phase 3 clinical trial, published in a letter to the editor in the Journal of the European Academy of Dermatology and Venereology.

The study recruited 964 adult patients with psoriatic arthritis and active plaque or nail psoriasis who had inadequate responses to 1 or more conventional synthetic disease-modifying rheumatic drug (csDMARD). Patients were randomly assigned 1:1 to receive either RZB 150 mg or placebo at weeks 0, 4 and 16. At week 24, all patients received open-label RZB every 12 weeks through week 208. Investigators assessed fingernail psoriasis severity with the modified Nail Psoriasis Severity Index (mNAPSI) and Physician’s Global Assessment of Fingernail Psoriasis (PGA-F).

After 24 weeks, patients treated with RZB had a least-squares (LS) mean change from baseline in mNAPSI of -9.30 points, and patients given a placebo had a -5.48 change (P <.001).  Patients receiving RZB had a -0.8-point change from baseline PGA-F vs a -0.4-point change from baseline for patients given a placebo (P <.001).

RZB-treated patients continued to improve in their mNAPSI and PGA-F scores through week 52, and patients in the placebo group showed a similar improvement trajectory after beginning RZB treatment at week 24.

At week 24, 38% (n=72) of RZB patients achieved PGA-F scores of “clear” or “minimal” compared with 18% (n=34) of placebo patients (P <.001). At week 52, 56% (n=105) of RZB patients achieved a PGA-F score of 0 or 1 with a >2-grade improvement compared with 45% (n=86) of patients who were given a placebo initially then switched to RZB at week 24.

At week 24, 24% (n=74) of RZB-treated patients had resolved fingernail psoriasis compared to 15% (n=51) of placebo-treated patients. Investigators found similar results when assessing fingernail psoriasis using PGA-F.

At week 52, about 41% of RZB-treated patients and 35% of placebo-then-RZB-treated patients had resolved fingernail psoriasis.

The study’s results demonstrated to the researchers that RZB “durably improved” fingernail psoriasis compared with placebo in patients with psoriatic arthritis who failed other csDMARD treatments – a population with “no standardized treatment evaluation,” the study authors wrote, calling for more research to be conducted in this area.

Disclosure: This study was funded by AbbVie. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Kristensen LE, Soliman AM, Papp K, et al. Effects of risankizumab on nail psoriasis in patients with active psoriatic arthritis: results from KEEPsAKE 1. J Eur Acad Dermatol Venereol. Published online January 15, 2022. doi:10.1111/jdv.17931