Matching-Adjusted Indirect Comparison of Risankizumab Versus Icotrokinra in Adult Patients with Moderate-to-Severe Plaque Psoriasis

Risankizumab (RZB) is an approved injectable IL-23 inhibitor with demonstrated high levels of skin clearance, and icotrokinra (ICO) is an oral IL-23 receptor blocker recently approved for the treatment of moderate-to-severe plaque psoriasis. In the absence of head-to-head trials, this study uses matching-adjusted indirect comparison (MAIC) to compare RZB with ICO in the treatment of adult patients with moderate-to-severe psoriasis. Individual patient data from phase 3 RZB trials and summary data from published ICO phase 3 trials were used in this MAIC through week 52. Risk differences between RZB and ICO placebo-adjusted response rates (anchored) were assessed for ≥ 75%, ≥ 90%, and 100% improvement in Psoriasis Area and Severity Index (PASI 75, PASI 90, and PASI 100) and Investigator’s Global Assessment (IGA) of 0 and 0/1 (IGA 0 and IGA 0/1) every 4 weeks up to week 16. Risk differences between RZB and ICO unadjusted response rates (unanchored) at weeks 24 and 52, along with confidence intervals and P-values, are also presented. At 16 weeks, the PBO-adjusted response rates (RZB versus ICO) were 80.6% versus 61.7%, with a risk difference (RD) of 18.9% (95% CI 11.5, 26.4; P < 0.001) for PASI 75; 71.4% versus 49.9% (RD: 21.5%; 95% CI 15.6, 27.4; P < 0.001) for PASI 90; 42.3% versus 29.4% (RD: 13.0%; 95% CI 7.9, 18.0; P < 0.001) for PASI 100; 77.8% versus 58.4% (RD: 19.4%; 95% CI 12.4, 26.3; P < 0.001) for IGA 0/1; and 41.6% versus 33.9% (RD: 7.7%; 95% CI 2.3, 13.0; P < 0.05) for IGA 0. Results were consistent in the unanchored analysis at weeks 24 and 52. In this analysis, adult patients with moderate-to-severe psoriasis treated with RZB demonstrated greater clinical efficacy as early as week 4 or 8, and through week 52 compared with ICO. This study compared two medicines for moderate-to-severe psoriasis: risankizumab, which is already approved and in use by patients, and icotrokinra, a recently approved oral medicine. There are currently no direct comparison studies, so an indirect comparison was used to compare results from separate clinical trials on each medicine. Clear skin was assessed using measures such as the degree of improvement (≥ 75%, ≥ 90%, or 100%) and doctors’ assessments. The results showed that at all assessed time points, patients treated with risankizumab were more likely to have clearer skin than patients treated with icotrokinra. For example, 71.4% of patients treated with risankizumab achieved at least 90% skin improvement, compared with 49.9% of patients treated with icotrokinra at week 16, and similar differences were observed at other levels of improvement and timepoints up to week 52. Overall, this indirect comparison found that more patients treated with risankizumab achieved clearer skin compared with patients treated with icotrokinra.