A higher dose of risankizumab may be required to effectively address psoriasis in patients with inflammatory bowel comorbidities, according to results of a case study published in Dermatologic Therapy.
Current treatment options for psoriasis include biologic agents that block the interleukin-23 (IL-23)/IL-17 axis. Although risankizumab is a humanized monoclonal antibody to the 19 subunit of IL-23 and has been approved for moderate to severe plaque psoriasis, the optimal dosage to address all psoriasis comorbidities has not yet been determined.
To determine the optimal dosage of risankizumab in patients with concurrent physical comorbidities to psoriasis, the treatment of a man 66 years of age who was diagnosed with psoriasis 26 years earlier, with psoriatic arthritis 4 years earlier, and also experienced ulcerative colitis for more than 10 years was analyzed. His treatment consisted of a monoclonal anti-TNF-α antibody, adalimumab, without improvement to his cutaneous lesions.
The patient was started on 300 mg of risankizumab at week 0, week 4, and every 12 weeks thereafter. After 4 weeks of treatment, the patient’s psoriasis area and severity index (PASI) score decreased from 17 to 5. During the next few months, the patient experienced worsening lesions, reaching PASI 7, as well as reactivation of his psoriatic arthritis and ulcerative rectocolitis. The addition of 40 to 60 mg/kg per day of sulfasalazine to his regimen improved his ulcerative rectocolitis, but not his arthralgia. Risankizumab treatment was halted at this time and adalimumab treatment was reinstated.
Studies have shown that higher induction doses of TNF antagonists are required for patients with Crohn’s disease compared with other indications, the study authors noted, likely due to the lower drug exposure from intestinal protein loss or a larger burden caused by inflammation. Following this pattern, it is likely that higher doses of risankizumab, namely at 600 mg, may be required for the effective treatment of psoriasis in patients with inflammatory bowel disease, the investigators believe. “The usefulness of a higher dose of risankizumab in psoriatic patients with comorbidities” was demonstrated in the treatment of this patient, they concluded.
Pensa C, Piccolo A, Zangrilli A, Bavetta M, Bianchi L. Risankizumab: How to choose the right dose in clinical practice? [published online October 6, 2020]. Dermatol Ther. doi:10.1111/dth.14371