Efficacy of Risankizumab in Moderate to Severe Psoriasis Considering Body Mass Index: A Scoping Review

Psoriasis is a chronic, immune-mediated inflammatory skin disease that significantly impacts patients quality of life and is frequently associated with obesity. This comorbidity may influence disease progression and treatment outcomes. Risankizumab, an interleukin-23 (IL-23) inhibitor, has demonstrated high efficacy in treating moderate to severe plaque psoriasis. However, its performance in obese patients remains unclear due to conflicting data. This scoping review aims to evaluate the impact of obesity, specifically BMI ≥ 30 kg/m², on the efficacy and safety of risankizumab in adults with moderate to severe plaque psoriasis. A comprehensive literature search was carried out in databases including PubMed, Scopus, JAMA, Elsevier, and Wiley, between December 2024 and February 2025. The selection included studies from 2020 to 2025, focusing on Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) outcomes in psoriatic patients receiving risankizumab, with or without obesity. 24 articles were included and analyzed by study design, patient characteristics, treatment response, and BMI influence. Risankizumab consistently demonstrated strong efficacy and safety in reducing PASI scores and improving DLQI across all BMI categories. While most studies reported no significant difference in response due to BMI, some suggested enhanced early responses in non-obese patients. Continuous treatment showed long-term benefits regardless of BMI, with 90% or greater improvement in the PASI (PASI90) and complete clearance (PASI100) maintained up to five years. Risankizumab is a highly effective and safe biologic therapy for moderate to severe psoriasis, even in patients across all BMI. Although some variations in response exist, the overall evidence supports its use across diverse patient profiles. Weight management should still be considered a complementary strategy in psoriasis care.