Newer IL-23 Inhibitor Demonstrates Improvement in Nail, Scalp, and Palmoplantar Psoriasis Advances

Several recent studies have demonstrated improvement in localized nail, scalp, and palmoplantar psoriasis after treatment with risankizumab.^1-3 The studies showed results in both real-world and clinical trial settings.

Risankizumab is a novel humanized IgG1 monoclonal antibody that selectively targets IL-23p19. It gained FDA approval in April 2019 for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy.

In the trial setting, risankizumab underwent two double-blind, randomized, placebo- and ustekinumab-controlled phase 3 trials (UltIMMa-1 and UltIMMa-2) of patients with moderate to severe disease plaque psoriasis.² Previous study has highlighted the improvements in psoriasis severity, quality of life, and mental health measures in patients receiving risankizumab.⁴ Additional analysis of these two trials revealed significant improvement in nail psoriasis severity index (NAPSI; P<.001) and psoriasis scalp severity index (PSSI; P<.001) after 52 weeks. Palmoplantar psoriasis severity index (PPASI) showed marked improvement as well (P=.061).²

More recent data out of Italy looked at real-world cases of psoriasis.³ In a single-center, prospective study, Megna et al³ looked at the efficacy and safety of risankizumab in 14 cases of psoriasis. After 4 and 16 weeks of treatment, patients had an overall significant improvement in Psoriasis Area and Severity Index and body surface area. Further, they noted an improvement in NAPSI, PSSI, and PPASI at week 16. No adverse events were reported, with the authors concluding that their “initial data confirm the promising results on efficacy and safety of risankizumab, even in a more challenging and “real” population, composed of a high percentage of multi-failure psoriatic patients who have benefitted from a new class agent.”

References
1. Challenging areas of the body: scalp palmoplantar, and nail psoriasis. AbbVie. Accessed September 29, 2021. https://www.skyrizihcp.com/clinical-efficacy/nails-scalp-palmoplantar-data

2. Elewski B, Rich P, Crowley J, et al. Risankizumab profile in nail, scalp, and palmoplantar psoriasis: efficacy and safety at 52 weeks in an integrated analysis of patients with moderate-to-severe plaque psoriasis. Presented at: 24th World Congress of Dermatology; June 10-15, 2019; Milan, Italy. Accessed September 29, 2021. https://www.wcd2019milan-dl.org/abstract-book/documents/abstracts/35-psoriasis/risankizumab-profile-in-nail-scalp-4251.pdf

3.Megna M, Cinelli E, Gallo L, Camela E, Ruggiero A, Fabbrocini G. Risankizumab in real life: preliminary results of efficacy and safety in psoriasis during a 16-week period. Arch Dermatol Res. Published online Feburary 20, 2021. doi:10.1007/s00403-021-02200-7

4. Patients receiving risankizumab report immediate and sustained improvements in severity, HRQL, and mental health in two phase 3 clinical trials. The Dermatologist. Accessed September 29, 2021.