Risankizumab vs. Ustekinumab for Psoriasis

Risankizumab vs. Ustekinumab for Psoriasis


Psoriasis is a chronic immune-mediated inflammatory
skin condition that can fluctuate in extent and severity. Interleukin-23 is a pro-inflammatory cytokine
that has a significant role in psoriasis pathogenesis because it regulates T cells, lymphoid cells,
and effector cytokines. Ustekinumab is a monoclonal antibody that
has shown efficacy in psoriasis and targets the p40 subunit, which inhibits two cytokines
– IL-23 and IL-12. Risankizumab is a monoclonal antibody that
targets p19 and specifically inhibits IL-23. A multi-center, international phase 2 study
assesed the efficacy and safety of risankizumab as compared with ustekinumab among 166 patients with
moderate-to-severe chronic plaque psoriasis. Patients were randomized to receive subcutaneous
injections of risankizumab, either as a single dose of 18mg, or as 90mg or 180mg repeated doses
several weeks apart, or ustekinumab at 45mg or 90mg as repeated doses several weeks apart. The primary end point was a 90% or greater
reduction from baseline to week 12 in the Psoriasis Area and Severity Index (PASI) score,
a measure of psoriasis severity. At week 12, the PASI90 response rate for pooled
analyses of 90mg or 180mg of risankizumab was 77% , as compared with 40% for ustekinumab,
a statistically significant difference. Among patients who received 90mg or 180mg
of risankizumab, PASI90 improvements were generally maintained up to 20 weeks after
the last dose. Common adverse events in both treatment groups
included nasopharyngitis and headache. Six patients treated with 90mg of risankizumab
had serious adverse events, including one patient who had an acute myocardial infarction
and another who suffered a stroke. The authors conclude that selective blockage
of IL-23 with risankizumab was associated with greater clinical response than ustekinumab. Full trial results are available at NEJM.org

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