Ken Gordon, MD: Insights on Risankizumab for Plaque Psoriasis

The UltIMMa trials compared risankizumab to ustekinumab in patients with moderate-to-severe plaque psoriasis. Over the course of 52 weeks, risankizumab demonstrated superiority in not only efficacy, but persistence of effect.

Ken Gordon, MD, Professor and Chair of Dermatology, Medical College of Wisconsin, Milwaukee, spoke with MD Magazine® about the UltIMMa 1 & 2 trial results at the 2019 Annual Meeting of the American Academy of Dermatology (AAD) in Washington, DC.

“The concept was, can you take these drugs that are viewed in a similar light, in terms of dosing and mechanism as well, and compare them to see if you have either equality or superiority,” said Gordon of the 2 studies.

The poster, “Efficacy and Safety of Risankizumab in Moderate-to-Severe Plaque Psoriasis: An Integrated Analysis of UltIMMa-1 and UltIMMa-2,” was shared at the AAD Annual Meeting, held March 1-5, 2019.

MD Mag: What did the UltIMMa trials investigate?

Gordon: So, the UltIMMa trials were comparator trials between risankizumab and ustekinumab. The difference between the 2 medications: ustekinumab is a molecule that blocks interlukin-12 and -23, risankizumab blocks interlukin-23 alone. There's an immunologic rationale behind that blocking interleukin-23 alone would actually be superior to blocking IL-12 and -23. And both the drugs are dosed similarly—[an initial dose at week 0, then] at week 4, and then every 12 weeks thereafter.

The concept was, can you take these drugs that are viewed in a similar light, in terms of dosing and mechanism as well, and compare them to see if you have either equality or superiority. In this case, risankizumab has—we've actually published—shown superiority to ustekinumab in both trials independently, and the integrated data set obviously shows that to be persistent. And then looking at the aspects of the response—and those include going out to 52 weeks and looking at how you maintain response for those 52 weeks—one of the really nice things about this trial—many times we've done comparator trials which have gone from the first 12 to 16 week dosing period and then switching over to the other medication, the medication that's being tested. In this case you have persistence of the comparator, which is extremely helpful in really trying to figure out how well things work in comparison. So, when you take a look at the dataset in total, you have significantly greater not only efficacy, but persistence of effect with the risankizumab. Additionally, when you look at dosing intervals, especially at the higher-level responses, you begin to see a little inconsistency in the ustekinumab response, which actually shows up in the clinic, where people are beginning to have little recurrences at the end of the dosing period that doesn't seem to happen with the risankizumab—it's a much more stable outcome. Those are the biggest aspects of what's been demonstrated here.