Risankizumab Versus Icotrokinra: New Data on Adults with Moderate-to-Severe Psoriasis

A new matching-adjusted indirect comparison (MAIC) study suggests risankizumab may provide greater clinical efficacy versus icotrokinra in adults with moderate-to-severe plaque psoriasis by several measures.1

The efficacy findings exemplified in this new study included higher rates of skin clearance noted by investigators as early as the initial weeks of treatment and these impacts’ sustenance through 1 year of use. The data were authored by such investigators as Linda Stein Gold, MD, of Henry Ford Health.

Stein Gold et al noted that as the therapeutic landscape for psoriasis evolves, there is a level of impracticality to direct head-to-head clinical research between every available medication. Consequently, indirect comparative analyses were described by the investigators as increasingly needed for helping clinicians interpret the relative efficacy of different drugs in the absence of randomized comparative studies.

“In the absence of head-to-head trials, this study uses matching-adjusted indirect comparison (MAIC) to compare [risankizumab] with [icotrokinra] in the treatment of adult patients with moderate-to-severe psoriasis,” Stein Gold and coauthors wrote.1,2

How MAIC Was Used to Evaluate Rizankizumab Versus Icotrokinra

The team of investigators used this MAIC in their analysis to look at the comparative efficacy of risankizumab and icotrokinra among adults living with moderate-to-severe plaque psoriasis. In Stein Gold et al’s analysis, they incorporated patient information drawn from phase 3 risankizumab studies and matched such data to published aggregate results from phase 3 icotrokinra trials.

Research looking at adults aged 18 years and older with moderate-to-severe psoriasis was included by the team, with this level of disease being defined by body surface area involvement of at least 10%, a Psoriasis Area and Severity Index (PASI) score of 12 or greater, and a static Physician Global Assessment (sPGA) or Investigator Global Assessment (IGA) score of 3 at minimum. Eligible studies were multinational, randomized phase 3 clinical studies. In order to ensure comparable populations among these data, the investigators selected trials sharing placebo or ustekinumab comparator groups.

Among those in the risankizumab cohort, individual patient-level data were pooled from the UltIMMa-1, UltIMMa-2, and IMMhance studies. Such findings were compared with pooled published findings from adults who had been included in the ICONIC-LEAD, ICONIC-ADVANCE-1, and ICONIC-ADVANCE-2 icotrokinra trials. Stein Gold and colleagues assessed clinical outcomes through the 52-week mark.

Placebo-adjusted analyses performed through the 16-week mark and unadjusted analyses extending through Weeks 24 and 52 were conducted. Overall, the investigative team’s main efficacy assessments included PASI 75, PASI 90, PASI 100, complete clearance (IGA 0), and IGA 0/1. They looked at these endpoints at 4-week intervals through Week 16, with their additional analyses being carried out at the 24 and 52-week marks.

How Does Risankizumab Compare to Icotrokinra for Psoriasis?

Risankizumab demonstrated, at the 16-week mark, significantly greater placebo-adjusted response rates across every endpoint assessed by Stein Gold and coauthors.1 The team highlighted the attainment of PASI 75 responses by an adjusted 80.6% of risankizumab-treated patients versus 61.7% of those receiving icotrokinra, for example. These findings corresponded to an absolute risk difference of 18.9% (95% CI, 11.5%-26.4%; P < .001).

In a similar finding, Stein Gold et al noted PASI 90 responses favored risankizumab, highlighting adjusted response rates of 71.4% as opposed to 49.9%, respectively.1 This yielded a 21.5% absolute difference (95% CI, 15.6%-27.4%; P < .001). Additionally, they found complete skin clearance (PASI 100) was seen more frequently among those on risankizumab. Specifically, 42.3% of those on risankizumab versus 29.4% among those on icotrokinra (risk difference, 13.0%; 95% CI, 7.9%-18.0%; P < .001).

Investigator-assessed disease activity also favored risankizumab, with the investigative team noting IGA 0/1 responses in 77.8% of indivduals treated with risankizumab as opposed to only 58.4% of those on icotrokinra.1 This suggested a 19.4% absolute advantage (95% CI, 12.4%-26.3%; P < .001). The team further identified complete physician-assessed clearance (IGA 0) more frequently among those on risankizumab, with response rates of 41.6% versus 33.9% (risk difference, 7.7%; 95% CI, 2.3%-13.0%; P < .05).

The investigators later added the data were consistent in the unanchored analyses conducted at both Weeks 24 and 52, suggesting to Stein gold and colleagues a level of persistence in the efficacy differences between treatments over longer follow-up.1 Notably, the found the analysis indicated the early emergence of risankizumab's clinical advantages during treatment. Differences favoring risankizumab were evident by Weeks 4 to 8 across several efficacy measures, Stein Gold et al found, and they were maintained throughout the 52-week observation period.

While they acknowledged indirect comparisons as not sufficient in replaing randomized head-to-head clinical research, the investigators did highlight MAIC analyses as a valuable method for informing treatment decisions when direct comparative evidence is unavailable.

References

1. Crowley J., Song EJ, 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.

2. Signorovitch JE, Sikirica V, Wu EQ, et al. Matching-adjusted indirect comparisons: a new tool for timely comparative effectiveness research. Value Health. 2012 Sep-Oct;15(6):940-7. doi: 10.1016/j.jval.2012.05.004. PMID: 22999145.