Risankizumab Significantly Improves Skin, Joint Symptoms in PsA

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Among a cohort of patients with psoriatic arthritis (PsA), treatment with risankizumab, an interleukin (IL)-23 inhibitor, was shown to disease activity and improve skin involvement, according to a study published in International Journal of Dermatology.¹

Despite a wide range of treatments available to help clinicians obtain and sustain joint and skin improvement among their patients with psoriasis, a substantial proportion of patients are still unable to achieve stable remission.²

“The IL-23/Th-17 axis is well recognized as an important contributor to the pathogenesis of cutaneous and extracutaneous inflammatory manifestations of psoriasis, including arthritis,” wrote a group of Italian investigators. “In particular, a central role of IL-23 has been demonstrated in peripheral enthesitis, which is currently considered the primum movens in the pathogenesis of most joint and tendon inflammatory manifestations of PsA.”

Although the efficacy and safety of risankizumab has been proven in 2 randomized controlled trials in patients with PsA (KEEPsAKE 1 and KEEPsAKE 2), real-world data is limited. In this multicenter study set in 8 Italian centers, investigators prospectively evaluated risankizumab treatment using both rheumatologic and dermatologic assessments, including joint and entheses ultrasound, at baseline and between 28—40 weeks of continuous therapy. Eligible patients were aged ≥ 18 years, were clinically diagnosed with PsA according to ClASsification criteria for Psoriatic Arthritis (CASPAR) criteria and confirmed by ultrasound detectable inflammatory joint/enthesis involvement, and were able to be treated with risankizumab.

The rheumatology evaluation included changes in the clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Leeds Enthesitis Index (LEI). Skin involvement was determined by the Psoriasis Area and Severity Index (PASI) as well as the Physician Global Assessment (PGA). Ultrasounds were conducted based on the European League Against Rheumatisms–Outcomes Measures in Rheumatology (EULAR-OMERACT) score and quality of life was evaluated using the Health Assessment Questionnaire (HAQ) and Dermatology Life Quality Index (DLQI). A univariate logistic regression model identified variables which could influence ultrasound response at follow-up and multivariate regression models were performed using variables that were deemed significant in the univariate analysis.

At baseline, the mean age of patients was 47.9 years, most (65%, n = 26) were female, and most reported a body mass index (BMI) of < 30 (70%, n = 28).

Post-treatment, the cDAPSA score decreased from a mean value of 12.9 ± 7.6 to 7.0 ± 6.1 (P <.001) and the power Doppler (PD) score decreased from 3 (range 1 — 8) at baseline to 1 (range 0 — 7; P <.001). Additionally, the PGA score decreased from 3.1 ± 1.0 to 0.4 ± 0.5 (P <.001) and the PASI score decreased from 8.4 ± 4.9 to 0.3 ± 0.5 (P <.001).

Treatment with risankizumab was not linked to any notable adverse events during the follow-up period and no cases of severe infection or treatment-related laboratory test abnormalities were reported.

Investigators note limitations such as the small sample size coupled with the short follow-up period comprised of only 2 assessments. Additionally, the clinicians who performed the ultrasound examinations were not blinded to the diagnosis and treatment of the patient. Lastly, patients with oligoarthritis, defined as having ≤ 4 joints/entheses involved, were included in the study.

“The present study provides real-world evidence of the clinical efficacy of risankizumab in the treatment of PsA,” investigators concluded. “Ultrasound assessments also confirmed clinical improvement; however, further and larger real-world cohort studies will be needed to support our observations.”

References

1. ^{Graceffa D, Zangrilli A, Caldarola G, et al. Effectiveness of risankizumab for the treatment of psoriatic arthritis: a multicenter, real-world study. Int J Dermatol. Published online April 7, 2024. doi:10.1111/ijd.17156}
2. ^{Coates LC, Mease PJ, Gossec L, Kirkham B, Sherif B, Gaillez C, et al. Minimal disease activity among active psoriatic arthritis patients treated with secukinumab: 2-year results from a multicenter, randomized, double-blind, parallel-group, placebo-controlled phase III study. Arthritis Care Res. 2018;70 1529-35.}