Risankizumab vs Secukinumab in Patients With Plaque Psoriasis

Psoriasis is a chronic disease that affects 2% to 3% of men and women.2 The disease is characterized by plaques and reddish scaly patches. Some women develop pustular psoriasis, which can be life-threatening if severe.3 Although most women with psoriasis notice symptom improvement during pregnancy, 10% to 20% have symptom deterioration.3 The effect of psoriasis on fetal health is unclear.2 Some studies have suggested that psoriasis, which is a TH1-driven disease, contributes to lower birth weight as observed in other TH1-driven diseases.2 The proposed negative effects of psoriasis on fetal health are usually linked to moderate or severe psoriasis. Topical corticosteroids are safe to use during pregnancy, but topical tar products, tazarotene, and retinoids are teratogenic and should be avoided.2,7 Ultraviolent B phototherapy is safe in pregnant women with moderate to severe psoriasis but may compromise folate levels.2 Limited data are available about the safety of biologics during pregnancy, and careful consideration is required before prescribing.2,7
The efficacy of risankizumab compared with secukinumab in treating patients with plaque psoriasis was compared across various patient subgroups.

A subgroup analysis from the IMMerge study shows a consistently greater efficiency of risankizumab compared with secukinumab when treating patients with plaque psoriasis, regardless of demographics or disease characteristics, according to findings from a study published in Dermatology and Therapy.

The study consisted of a 30-day screening process, a 52-week open-label treatment period, and a 16-week follow-up period. Criteria for participation included: adults with plaque psoriasis for at least 6 months, plaque psoriasis over at least 10% of body surface area, a static Physician’s Global Assessment (sPGA) of 3 or higher, and a Psoriasis Area Severity Index (PASI) of 12 or higher.

In total, 409 patients were screened, and 327 patients were selected to participate. Eligible candidates were randomly assigned to risankizumab 150 mg at weeks 0,4, and every 12 weeks thereafter until the last dose at week 40 or secukinumab 300 mg at weeks 0,1,2,3,4, and every 4 weeks thereafter until the last dose at week 48.  Most patients were men (65%) and the average age was 47.1 years. A greater percentage of patients (74.1-92.3%) treated with risankizumab achieved PASI 90 at week 52, compared with those treated with secukinumab (46.8-65.0%). The clinical response of those treated with risankizumab was consistent across patient subgroups including age, sex, and baseline disease severity.By comparison, secukinumab clinical response varied by age (younger than 40 years), BMI (<30kg/m2), and previous treatment subgroups.

One of the aims of this study was to find an efficient therapy for patients regardless of previous treatment history and personal characteristics. In general, it was noted, it is difficult to treat patients with obesity and plaque psoriasis as a lower treatment response is usually reported in this patient population. However, regardless of weight, greater numbers of patients treated with risankizumab achieved clinical improvement by week 52. These results indicated to the investigators that risankizumab provides efficient and effective treatment to overweight patients who previously experienced dose adjustment or changes in dose frequency to achieve positive effects.

Patients who discontinue their first biologic agent due to treatment failure or loss of efficacy go on to report lower efficacy of second- or third-line biologic agents. However, with risankizumab, regardless of previous biologic agent use and failure, an increased number of patients achieved PASI 90 at 52 weeks when treated with risankizumab compared with secukinumab.

Based on the data, researchers  concluded, “Overall, risankizumab showed greater efficacy compared to secukinumab consistently across different patient groups, regardless of baseline demographics and disease characteristics….These data showed risankizumab is a durable treatment for plaque psoriasis across many patients, including those with greater body weight and those who have had less than adequate response to other biologics.”

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


Crowley JJ, Langley RG, Gordon KB, et al. Efficacy of risankizumab versus secukinumab in patients with moderate-to-severe psoriasis: Subgroup analysis from the IMMerge study. Dermatology and Therapy. Published online January 20, 2022. doi: 10.1007/s13555-021-00679-6.