Risankizumab for the treatment of genital psoriasis: A 1‐year, real‐world experience

Abstract

Dear Editor, Genital involvement is frequently reported in patients with psoriasis and is associated with a major impact on quality of life (QoL) and embarrassment in engaging sexual intercourses. [1][2][3] Only 40% of patients reported to have had a previous examination of the genital area, and therefore treatment is often initiated late. 2 Genitals are considered a difficult-to-treat area. 4,5 Topical treatments remain the first-line choice for mild-to-moderate disease. 5 However, corticosteroids are associated with longterm adverse events, and specific data on immunomodulators or vitamin D derivatives are scant. Systemic treatments also have a role for moderate-to-severe disease, but evidence is mostly anecdotal also for those therapies. 4,5 Risankizumab is a humanized monoclonal antibody that blocks the p19 subunit of interleukin (IL)-23, which proved effective in clinical trials and field-practice experiences. 6,7 However, specific experiences on the treatment of genital psoriasis with risankizumab are scant and have a short follow-up. [8][9][10] We conducted a retrospective, 'real-world' study, with a 1-year follow-up, on risankizumab in the treatment of genital psoriasis. Consecutive adult (≥18 years) patients with moderate-to-severe plaque psoriasis involving the genital area and treated with risankizumab (150 mg administered subcutaneously at weeks 0, 4 and every 12 weeks thereafter) were enrolled. According to the standard protocol, assessment of effectiveness and safety was performed at baseline and after 16, 28, 40 and 52 weeks. The effectiveness of risankizumab was evaluated in terms of percentage reduction of Psoriasis Area and Severity Index (PASI) compared with baseline. In particular, the impact of the treatment on genital psoriasis was assessed by using the static Physician's Global Assessment of Genitalia (s-PGA-G), which ranges from 0 (no psoriasis) to 5 (very severe disease). 10 Safety was investigated by reporting the occurrence of any adverse events (AEs) throughout the study.In total, 93 patients were enrolled (69 males, 75%; mean age 48.2 ± 15.5 years; Table 1). The mean PASI at baseline was 19.1 ± 11.3, and 25 patients (26.9%) had severe involvement of genitalia (s-PGA-G ≥ 4). All patients completed at least 16 weeks of treatment, and 79 reached the 52-week follow-up .At baseline, the mean s-PGA-G was 3.1 ± 0.8. During the study, it decreased to 0.41 ± 0.24 at week 16, 0.21 ± 0.17

Effectiveness of ixekizumab for the treatment of moderate‐to‐severe plaque psoriasis with involvement of difficult‐to‐treat areas: A 52‐week multicenter retrospective study

“…12 Among interleukin inhibitors, ixekizumab and risankizumab appear to be the drugs with the highest effectiveness on difficult-to-treat areas, according to data from both clinical trials and real-world experience. [9][10][11][12][13] The safety profile of ixekizumab in our study was very high as no serious AEs or AEs leading to discontinuation were observed, consistent with the results of a 5-year analysis of the UNCOVER-3 study. 14 The main limitations of this study include are the retrospective nature and the absence of a control group, which do not allow the generalization of our findings.…”

Effectiveness, Tolerability, and Drug Survival of Risankizumab in a Real-World Setting: A Three-Year Retrospective Multicenter Study—IL PSO (ITALIAN LANDSCAPE PSORIASIS)

“…However, from week 52 onwards, these differences were no longer recorded, except for PASI100 at week 52, which could be explained by a minimal residual PASI in these areas [13,19,22]. In our study, risankizumab was rapidly effective, particularly in patients with genital psoriasis, which improved patient well-being [23]. Our results support the use of risankizumab in patients involving difficultto-treat areas due to its high effectiveness in the long term.…”