Dr Khattri on Risankizumab for Psoriatic Arthritis: Updates and Insights

Recently, the Food and Drug Administration announced approval of risankizumab-rzaa¹ for the treatment of active psoriatic arthritis in adult patients. Risankizumab-rzaa is the only interleukin (IL)-23 inhibitor to be approved for adults with moderate to severe plaque psoriasis and active psoriatic arthritis that can be administered with a single injection 4 times a year after 2 starter doses at weeks 0 and 4.

In this exclusive interview with The Dermatologist, Saakshi Khattri, MD, discusses what this approval means for clinicians and the psoriatic disease community. Dr Khattri is a board-certified dermatologist and rheumatologist and director of the Dermatology/Rheumatology service at Mount Sinai in New York, New York. She has been involved in research on psoriasis and psoriatic arthritis, including clinical trials for both conditions.

How can the durability of risankizumab affect the quality of life among patients with psoriasis and psoriatic arthritis?
Pain associated with active psoriatic arthritis significantly impacts quality of life for patients. In fact, a 2019 study² of patients with psoriatic arthritis found that pain reduction was ranked as their primary treatment goal. Patient’s assessment of pain is one of the key components of ACR20 and in the 2 KEEPsAKE trials, risankizumab achieved the primary endpoint of ACR20 response at week 24 compared with placebo in addition to showing improvement in other key manifestations of psoriatic arthritis.

How does risankizumab compare with disease-modifying antirheumatic drugs (DMARDs) or IL-17A inhibitors (eg, recently approved secukinumab)?
Currently, there aren’t any head-to-head trials between IL-23s and IL-17A inhibitors in psoriatic arthritis, so we can’t draw any conclusions.

However, we do know that risankizumab is the only IL-23 with a quarterly dosing schedule after starter doses at week 0 and week 4 and has robust ACR20 data in addition to data for enthesitis, dactylitis, and skin improvements.

Are there adverse effects dermatologists should be aware of and monitor their patients for when using risankizumab?
The safety profile observed in patients with psoriatic arthritis treated with risankizumab is generally consistent with the safety profile in subjects with plaque psoriasis. When treating patients with risankizumab, dermatologists should be aware of potential adverse hypersensitivity reactions, which are noted in the medication package insert.

Besides a pretreatment evaluation for tuberculosis, risankizumab requires no additional laboratory test monitoring and has no label warnings or precautions for malignancy, inflammatory bowel disease, depression, or candidiasis. This is positive news for patients who may be concerned with potential side effects.

Do you want to share any further insights regarding the management of psoriatic disease or risankizumab-rzaa?
One-third of psoriasis patients also have psoriatic arthritis. Despite this overlap, there remains a delay in diagnosis and appropriate treatment of psoriatic arthritis, which can translate to poorer radiographic and functional outcomes.

As a practicing dermatologist and rheumatologist, it’s great news to have another treatment option with risankizumab for my patients with active psoriatic arthritis—especially with robust data across ACR20 and other domains like enthesitis and dactylitis and a quarterly dosing schedule for patients opposed to more frequent injections.

Reference

1. US FDA approves second indication for SKYRIZI® (risankizumab-rzaa) to treat adults with active psoriatic arthritis. News release. Abbvie. January 21, 2022. Accessed January 28, 2022. https://news.abbvie.com/news/press-releases/us-fda-approves-second-indication-for-skyrizi-risankizumab-rzaa-to-treat-adults-with-active-psoriatic-arthritis.htm

2. Ogdie A, Elaine Husni M, Bush K, et al. AB0769 patient identified treatment goals in psoriatic arthritis: decreasing pain and increasing activity level are high priorities. Paper presented at: Annual European Congress of Rheumatology; June 12-15, 2019; Madrid, Spain. Accessed February 9, 2022. https://ard.bmj.com/content/78/Suppl_2/1853