Risankizumab Effectively Clears Psoriasis in Indirect Comparison to Deucravacitinib

April W. Armstrong, MD, MPH

Credit: LinkedIn

In placebo-anchored matching-adjusted indirect comparison (MAIC) analysis, risankizumab achieved an elevated rate of skin clearance and greater quality of life improvements versus deucravacitinib in patients with moderate-to-severe plaque psoriasis (PsO).¹

The comparative effectiveness study was based on an MAIC of data from 4 Phase 3 clinical trials for risankizumab (UltIMMa-1 and UltIMMa-2) and deucravacitinib (POETYK PSO-1 and POETYK PSO-2) conducted among patients with moderate-to-severe PsO.

“By providing more information regarding the comparative effectiveness between risankizumab and deucravacitinib, this study will allow healthcare professionals to optimize their treatment decisions for patients with moderate-to-severe PsO,” wrote the investigative team, led by April W. Armstrong, MD, MPH, a professor of dermatology at the Keck School of Medicine, University of Southern California.

Advancements in PsO treatment, driven by the US Food and Drug Administration (FDA) approvals of risankizumab in 2019 and deucravacitinib in 2022, have transformed disease management in dermatology.^2,3 Still, there is little head-to-head data on the comparative effectiveness of the two therapies, limiting the greater understanding of the treatments for PsO.

Citing the “ever-changing landscape and the number of treatments” for PsO, Armstrong and colleagues noted it was not feasible to conduct head-to-head trials to compare all available therapies.¹ For this analysis, the investigative team used MAIC methodology to evaluate the comparative clinical benefit of risankizumab and deucravacitinib in moderate-to-severe PsO.

All trials defined moderate-to-severe PsO as body surface area involvement ≥10%, Static Physician’s Global Assessment (sPGA) ≥3, and Psoriasis Area and Severity Index (PASI) ≥12. Individual patient data from the UltIMMa-1 and UltIMMa-2 trials were weighted via propensity scores to match POETYK PSO-1 and POETYK PSO-2 published summary data.

Rate differences between the two therapies were evaluated at 16 weeks, including the proportion of patients achieving PASI 75/90/100, the proportion of patients achieving clear or almost clear or clear skin (sPGA, 0 or 0/1), and the proportion of patients experiencing little to no impact of PsO on health-related quality of life (Dermatology Life Quality Index [DLQI] 0/1).

Overall, the analysis involved 598 patients treated with risankizumab and 200 patients in the associated placebo cohort, and 843 patients treated with deucravacitinib and 421 in the associated placebo cohort. After individual patient data were matched between populations, baseline characteristics were well-balanced.

At 16 weeks of treatment, approximately 91% of patients receiving risankziumab achieved PASI 75 versus 55.2% of deucravacitinib-treated patients, demonstrating statistically higher rates of skin clearance (P <.001). Approximately 77% and 44.2% of patients receiving risankziumab achieved PASI 90 and PASI 100, respectively, compared with 30.4% and 11.7% of deucravacitinib-treated patients (both P <.001).

Moreover, risankziumab-treated patients achieved greater improvements in quality of life than those treated with deucravacitinib, including sPGA 0 (44.5% vs. 16.4%), sPGA 0/1 (85.6% vs. 51.1%), and DLQI 0/1 (70.6% vs. 37.7%), after 16 weeks of treatment. For all outcomes, the number needed to treat (NNT) was lower for risankizumab compared with deucravacitinib.

Noting the limitations of MAIC, Armstrong and colleagues addressed the potential for bias as not all cross-study differences can be addressed by the inclusion and exclusion criteria. The team noted the generalizability of these results remained limited, as real-world data can differ from clinical trials, but pointed to their consistency with recent literature.

“By comparing these treatments via MAIC, our results are unlikely to be due to differences in the baseline characteristics of the patients,” they added. “The findings of this analysis are also consistent with that reported in a recent network meta-analysis that compared deucravacitinib to other biologic and nonbiologic treatments for PsO.”

References

1. _{Armstrong AW, Soliman AM, Gisondi P, Fang S, Patel M, Strober B. Matching-Adjusted Indirect Comparison of Risankizumab Versus Deucravacitinib in Patients with Moderate-to-Severe Plaque Psoriasis. Dermatol Ther (Heidelb). 2024 Oct 25. doi: 10.1007/s13555-024-01293-y. Epub ahead of print. PMID: 39453596.}
2. _{Hoy SM. Deucravacitinib: First Approval. Drugs. 2022 Nov;82(17):1671-1679. doi: 10.1007/s40265-022-01796-y. PMID: 36401743; PMCID: PMC9676857.}
3. _{McKeage K, Duggan S. Risankizumab: First Global Approval. Drugs. 2019 Jun;79(8):893-900. doi: 10.1007/s40265-019-01136-7. PMID: 31098898.}