The findings suggest that risankizumab may provide a faster onset of response and more durable disease control than icotrokinra in the treatment of moderate-to-severe plaque psoriasis. However, further head-to-head studies are needed to confirm these comparative findings.
Moderate-to-severe plaque psoriasis is a chronic inflammatory skin disease that often requires systemic therapy to achieve sustained disease control. Risankizumab, an injectable interleukin-23 (IL-23) inhibitor, has demonstrated high rates of skin clearance in clinical trials, while icotrokinra, a recently approved oral IL-23 receptor blocker, offers a new oral treatment option. As no direct comparative trials between the two therapies are currently available, researchers conducted a matching-adjusted indirect comparison (MAIC) to evaluate their relative efficacy.
The study, led by Jeffrey Crowley of Bakersfield Dermatology and Skin Cancer Medical Group, USA, combined individual patient data from phase 3 risankizumab trials with published summary data from phase 3 icotrokinra trials. The investigators compared treatment responses through 52 weeks using established psoriasis outcomes, including at least 75%, 90%, and 100% improvement in the Psoriasis Area and Severity Index (PASI 75, PASI 90, and PASI 100), along with Investigator’s Global Assessment (IGA) scores of 0 and 0/1.
Key Findings:
- At week 16, 80.6% of patients treated with risankizumab achieved PASI 75, compared with 61.7% of those treated with icotrokinra.
- PASI 90 was achieved by 71.4% of patients receiving risankizumab versus 49.9% receiving icotrokinra.
- Complete skin clearance (PASI 100) was reported in 42.3% of patients treated with risankizumab compared with 29.4% of those treated with icotrokinra.
- IGA 0/1 was achieved by 77.8% of patients receiving risankizumab versus 58.4% receiving icotrokinra.
- IGA 0 was achieved by 41.6% of patients treated with risankizumab compared with 33.9% treated with icotrokinra.
- All efficacy outcomes significantly favored risankizumab over icotrokinra.
- Higher response rates with risankizumab were observed as early as weeks 4 to 8.
- The superior efficacy of risankizumab was maintained through week 16 and remained consistent at weeks 24 and 52, indicating sustained clinical benefit over one year.
The investigators noted that, in the absence of direct head-to-head trials, matching-adjusted indirect comparisons can help inform treatment selection and shared decision-making.
The researchers concluded that risankizumab demonstrated greater clinical efficacy than icotrokinra across multiple skin clearance outcomes from the early weeks of treatment through week 52. However, they emphasized that the findings are based on an indirect comparison and require confirmation in prospective head-to-head clinical trials.
Reference:
Crowley, J., Song, E.J., Stein-Gold, L. et al. Matching-Adjusted Indirect Comparison of Risankizumab Versus Icotrokinra in Adult Patients with Moderate-to-Severe Plaque Psoriasis. Dermatol Ther (Heidelb) (2026). https://doi.org/10.1007/s13555-026-01839-2
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