Switching to risankizumab successful in IL-17 inhibitor non-responders

In daily practice, many patients are switched from one biologic to another with no washout period. The aIMM study demonstrated that switching patients to risankizumab for difficult-to-treat psoriasis is both safe and effective.

With more and more biologics entering the therapeutic arena, it is important to know the consequences of switching between biologics. As Prof. Richard Warren (University of Manchester, UK) pointed out, data from the phase 3 aIMM study (NCT04102007) “gives us a very clear definition of suboptimal response and the very clear benefit of switching to risankizumab, offering further scientific proof when considering treatment options for patients”.

In the open, single-arm study, all included patients (n=252) had to be on an IL-17 blocker (i.e. secukinumab or ixekizumab) for at least 6 months and show a suboptimal response (defined as static Physicians’ Global Assessment [sPGA] 2/3 and body surface area affected 3% to <10%) on treatment. They were then treated with 150 mg risankizumab at weeks 0, 4, and every 12 weeks through week 40 without a washout period. “That reflects reasonably what we do in clinical practice,” Prof. Warren commented on the study design.

The primary study endpoint was the percentage of participants achieving a PGA 0/1 (i.e. clear or almost clear skin) at week 16 after switching. In addition, the percentage of participants achieving PGA 0, a Dermatology Life Quality Index of 0 (i.e quality of life no longer impaired by the disease), and Psoriasis Symptom Scale (PSS) scores were assessed at week 16 and 52 as secondary endpoints. “The mean disease duration was 20.8 years; this is a tough-to-treat population,” Prof. Warren said.

At week 16, 52% of the participants treated with risankizumab achieved the primary endpoint (sPGA 0/1). Moreover, participants demonstrated a numerical improvement in all endpoints between week 16 and week 52. “Between weeks 16 and 52, there is an accrual of each outcome,” Prof. Warren said. An sPGA of 0/1 was achieved by 63% of the participants and 46% achieved an Dermatology Life Quality Index (DLQI) scores of 0/1 (i.e. no effect on patient’s life). A PSS of 0 was achieved by 27.4% of participants at this time; a “hard-to-meet endpoint,” as Prof. Warren put it. No new safety signals were observed in this analysis.

1. Warren R. Efficacy and safety after 52 weeks in psoriasis patients switching to risankizumab after suboptimal response to secukinumab or ixekizumab. S025, AAD 2023 Annual Meeting, 17–21 March, New Orleans, USA.

Posted on 15 May, 2023