Risankizumab Demonstrates Superior Efficacy in Treating Plaque Psoriasis as Compared to Apremilast in Phase 4 Study

In a recent study published in the British Journal of Dermatology, it was found that for patients with moderate psoriasis, treatment with risankizumab demonstrated superior efficacy compared to apremilast.


AbbVie’s phase 4 head-to-head study, IMMpulse, evaluated both risankizumab, an interleukin-23 inhibitor, and apremilast, which inhibits phosphodiesterase 4.

The study was a multicenter, randomized, open-label, efficacy assessor-blinded study which took place over the course of 52 weeks. It included a total of 352 patients over 18 years with a diagnosis of moderate chronic plaque psoriasis who were candidates for systemic therapy. Of these, 118 received subcutaneous risankizumab at a dosage of 150 mg at week zero and week four. A total of 235 received oral apremilast at a dosage of 30 mg twice a day.

At week 16, if those patients receiving apremilast had not achieved a Psoriasis Area and Severity Index (PASI) 75 response, they were re-randomized to receive either risankizumab or apremilast.

At week 16, results showed that 55.9% of patients treated with risankizumab achieved the co-primary endpoint of PASI 90 compared to only 5.1% of those treated with apremilast.

As for the co-primary endpoint of static Physician’s Global Assessment (sPGA) 0/1, this was achieved by 75.4% of those treated with risankizumab compared to 18.4% of apremilast-treated patients.

A total of 83 apremilast-treated patients who failed to reach PASI 75 by week 16 were switched to risankizumab and 78 continued with apremilast. By week 52, 72.3% of these patients who had switched to risankizumab had achieved PASI 90 compared to only 2.6% who continued on apremilast.

Of those patients who received continuous treatment, results at 52 weeks demonstrated that 73.7% of those treated with risankizumab achieved PASI 90, and 63.6% achieved PASI 100. For those treated with apremilast, 4.5% achieved PASI 90 by week 52 and 2.7% PASI 100.

Patients were also provided with a Treatment Satisfaction Questionnaire for Medication. At week 16, those treated with risankizumab reported higher overall scores than those treated with apremilast:

Satisfaction with Effectiveness
Satisfaction with Convenience
Global Satisfaction

The most frequent adverse events reported in risankizumab were COVID-19 and nasopharyngitis. For those receiving apremilast, diarrhea, nausea, and headaches were most common.

The study concluded that “risankizumab treatment can significantly improve clinical outcomes in systemic-eligible patients with moderate psoriasis compared to apremilast.”


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