Linda Stein Gold, MD: Comparing Risankizumab Versus Apremilast for Psoriasis

During her interview with the HCPLive editorial team, Linda Stein Gold, MD, vice president of the American Academy of Dermatology and head of the division of dermatology at the Henry Ford Health System, spoke on several of her team’s recent findings from the phase 4 IMMpulse study.

Stein Gold discussed the findings on risankizumab versus apremilast on patients with psoriasis, as well as their implications and application in the research and clinical practice landscape. The data were presented at the 2024 American Academy of Dermatology (AAD) Annual Meeting.

“We did a sub-analysis in this impulse study and we looked specifically at those patients who had scalp disease and those patients who had nail disease,” Stein gold said. “Looking first at the scalp…with risankizumab, we saw at Week 4 a mean change of about 50% improvement in their scalp overall, compared with about 21% improvement with apremilast and that improvement continued. By Week 16, we saw about an 88% improvement with risankizumab and less than half that with apremilast.”

Stein Gold noted that this improvement stabilized and continued for both groups at close to the same level over the course of 52 weeks. She noted there had been a greater depth of response and overall faster response with risankizumab.

“Now nails grow quite a bit slower, but we did start to see a bit of separation between the 2 active groups at Week 4 and week 16,” Stein Gold explained. “Again, we saw about a doubling of the efficacy with the risankizumab group compared with apremilast. So about 27% versus 14%. Then as we go out over a year, we really need to have some time for these nails to grow out completely. We found about an 80% mean change in the NAPSI score with risankizumab as compared to about 39% with apremilast.”

Stein Gold also noted that there had been a faster and, again, a more complete depth of response in the nails, as had been observed with the scalp results. Later, she was asked about the findings’ implications for clinical practice.

“So some people definitely prefer a pill over a shot, and we know that especially in those moderate patients,” Stein Gold said. “But we did an analysis of the psoriasis symptom scores and we looked at these patients at Week 4 and also Week 16. Consistently, we saw a better improvement with risankizumab as compared with apremilast. And even, for instance, in the impact on the overall Dermatology Life Quality Index or the overall quality of life, we saw a higher number of patients treated with risankizumab had a DLQI score of 0 or 1.”

This, Stein Gold noted, meant almost no impact on the overall quality of life.

“So what I would say is patients who have moderate disease still matter,” Stein Gold said. “Even though it might be 10 or 12 or 13% BSA, it still has a major impact. It affects these patients emotionally and socially. It affects their work, it affects their social interactions to a high degree. It’s to as high a degree as if they were covered with psoriasis. I would say ideally we would try to get these patients under control as completely as possible.”

For further information on these findings and Stein Gold’s summary of their importance, view the full interview above or read our previous coverage of the topic.

The quotes contained in this summary were edited for the purposes of clarity.