A new study demonstrates the benefits of IL-23 inhibitors like risankizumab on patients with moderate to severe plaque psoriasis. Treatments involving anti-IL-23 agents have been shown to have the lowest rates of adverse events.
Regarding both short-term and long-term use, risankizumab had the best long term risk-benefit profile of all the IL-23 inhibitors represented in the data.
Data from 52 randomised controlled trials of oral and biologic medicines for moderate to severe plaque psoriasis showed researchers the short-term safety outcomes for 16 treatments over 12 to 16 weeks from baseline. Seven of the 52 trials showed long-term safety outcomes over 48 to 56 weeks from baseline over the course of seven treatments.
The lowest rates of any adverse events in the short term were associated with treatments using tildrakizumab (46% for 200mg Q12W), entanercept (49.1%), risankizumab (52.4%), and guselkumab (55.8%).
The lowest rates of serious adverse events were associated with treatments involving certolizumab (0.8% for 200 mg Q2W), risankizumab (1.2%), entanercept (1.6%), and dimethyl fumerate (1.8%).
At 0.5%, risankizumab had notably low odds of adverse events that could lead to discontinued treatment in the short term. In terms of long-term use, risankizumab had the lowest rates of any adverse events at 67.5%, serious adverse events at 4.4%, and discontinued treatment due to adverse events at 1.0%.
The second lowest rates of any adverse events in the long term were found with guselkumab (72.2%). This treatment also had the third-lowest rate of discontinuation of treatment due to adverse events (2.5%).
The researchers noted that one limitation of the study involves the possibility that the clinical trials analysed may not represent real-world scenarios. Another limitation of the study concerns the rates of specific adverse events like infections.
Dr. Zenas Yiu, a clinical lecturer at the University of Manchester, in the UK, believes safety benefits revealed in the analysis should be validated by safety registries as trial data cannot fully reflect the clinic. Dr. Yiu did not take part in the research study.
Dr. Yiu added that whilst risankizumab appears to have the best benefit-risk profile, the reasons why are not clear. This observation does not mitigate the fact that IL-23 inhibitors have the potential to be better for psoriasis than other treatments.
The study was published in the Journal of the American Academy of Dermatology in February 2021.
