Real-world practice indirect comparison between guselkumab, risankizumab, and tildrakizumab: results from an Italian 28-week retrospective study

Abstract

Background

Guselkumab, tildrakizumab, and risankizumab, acting on interleukin(IL)23 axis, have been recently approved for psoriasis management. However, real-life data regarding their comparison are scant.

Objectives

The aim of our real life study was to perform an indirect efficacy and safety comparison among anti-IL23s, particularly focusing on difficult-to-treat areas.

Methods

A 2-year single-center retrospective observational study was performed enrolling moderate-to-severe psoriasis patients treated with anti-IL23. For each patient, clinical and demographical data were collected at baseline and at week4, week16, and week28. PASI, BSA, NAPSI, and specific BSA regarding difficult to treat areas were evaluated.

Results

One hundred and fifty patients were included in the study: 63 (42%) received guselkumab, 21 (14%) tildrakizumab, and 66 (44%) risankizumab. The three groups were comparable for age, sex, and disease severity, only differing for psoriasis duration, psoriatic arthritis prevalence (higher in guselkumab), and previous systemic treatment failure (lower for tildrakizumab). Mean PASI and BSA significantly reduced from baseline up to week 28 without significant differences among the 3 drugs (reduction of 95–97.3% for PASI and 94.8–96.7% for BSA). No significant differences were registered for PASI75, 90, or 100 responses, in particular, PASI100 was reached by 73.4–85% of patients. As regards difficult-to-treat areas, all the drugs displayed a high efficacy, with significant differences registered only for the rapidity of action on palmoplantar psoriasis.

Conclusions

Our 28-weeks study demonstrated a comparable efficacy and safety profile for all anti-IL23, with guselkumab and risankizumab appearing slightly faster than tildrakizumab particularly on palmoplantar lesions in the short-term.

What is already known about this topic?

• The interleukins (IL) 23/17 axis seems to play a key role in psoriasis management.

• Guselkumab, tildrakizumab, and risankizumab, selectively blocking the IL23 signaling, have been recently approved for psoriasis management.

• Real-world data regarding different anti-IL23 comparisons are scant.

What does this study add?

• Our 28-weeks study showed that there were not any significant differences in terms of efficacy and safety between each anti-IL-23 apart from palmoplantar area where guselkumab and risankizumab showed higher efficacy.

• Globally risankizumab and guselkumab appeared slightly faster than tildrakizumab.

• Guselkumab, tildrakizumab, and risankizumab are valid weapons for psoriasis management, also for difficult-to-treat areas (scalp, nails, genitalia, lower limbs, and palmo-plantar area).

Keywords:

• Psoriasis
• real life
• anti-IL23
• risankizumab
• guselkumab
• tildrakizumab

Author contributions

Megna Matteo: conceptualization, validation, visualization, writing-original draft preparation, and writing-review and editing. Tommasino Nello, Potestio Luca, Battista Teresa, Ruggiero Angelo, and Noto Matteo: data curation, investigation, methodology, visualization, and writing-original draft preparation. Fabbrocini Gabriella: conceptualization, validation, visualization, writing-review and editing, and supervision. Genco Lucia: data curation, investigation, methodology, visualization, and writing-original draft preparation. All authors read and approved the final version of the manuscript.

Disclosure statement

Matteo Megna acted as a speaker or consultant for Abbvie, Novartis, Eli Lilly, Janssen, UCB, Amgen, and Leo Pharma; Gabriella Fabbrocini acted as a speaker or consultant for Abbvie, Novartis, Eli Lilly, Janssen, UCB, Amgen, Leo Pharma, and Almirall. The remaining authors report no conflicts of interest.

Data availability statement

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.