Risankizumab for plaque psoriasis in difficult-to-treat areas

Risankizumab, an interleukin 23 inhibitor, has shown efficacy in treating plaque psoriasis in clinical trials, however there is a lack of data available for its efficacy in patients with psoriasis affecting difficult-to-treat areas.¹

Up to 65% of individuals with plaque psoriasis may have scalp or facial involvement.¹ Other areas affected can include nails, palms/soles, and genitalia (in up to 60%, 26%, and 43% of patients, respectively).¹ Generally, psoriasis in these areas does not respond to conventional treatments including topical corticosteroids and vitamin D derivatives.¹

Here, we summarize a publication published by Orsini et al.¹ in Journal of Dermatological Treatment on the efficacy of rizankizumab on plaque psoriasis in difficult to treat areas.

Methods and patient population

This was a 52-week retrospective study from two referral centers including 202 patients with moderate-to-severe involvement of at least 1 difficult-to-treat area, which was defined by site-specific Physician’s Global Assessment (PGA) ≥3.

• In this study:
  • duration of psoriasis was a mean of 17.27 years;
  • 72 patients had ≤1 cardiometabolic comorbidity;
  • 165 patients had scalp involvement;
  • 72 had genital psoriasis;
  • 50 had nail psoriasis; and
  • 21 had palmoplantar psoriasis.

Key findings 

• PGA scores in each difficult-to-treat area, from Week 16 to Week 52, are shown in Figure 1.
• In all difficult-to-treat areas, the proportion of patients achieving PGA 0/1 increased from Week 16 to Week 52, with the greatest increase seen in palmoplantar and nail psoriasis.
• There were no patient discontinuations due to treatment-emergent adverse events or serious adverse events.

Figure 1. Proportion of patients achieving PGA 0/1 in the scalp, palms/soles, genitalia, and nails* 

f-PGA, fingernail PGA; pp-PGA, palmoplantar Physician’s Global Assessment, sc-PGA, scalp-specific Physician’s Global Assessment; PGA sPGA-G, static Physician’s Global Assessment of Genitalia.
*Adapted from Orsini, et al.¹