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.

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

Key learnings

In this study, risankizumab was effective in treating difficult-to-treat areas of psoriasis rapidly, with sustained efficacy up to Week 52. Comparative studies of risankizumab versus other interleukin inhibitors in this patient group would be advantageous, as studies of this nature are currently limited.