Are there any drug interactions or contraindications between Skyrizi (rizankizumab) and cardiovascular medications for a patient with Autoimmune Psoriatic-Arthritis, previously treated with Taltz (ixekizumab) and currently using topical steroid ointment?

Drug Interactions and Contraindications for Skyrizi (Risankizumab) in Psoriatic Arthritis

Skyrizi (risankizumab) has no significant drug interactions with cardiovascular medications and can be safely used in patients with cardiovascular conditions, unlike TNF inhibitors which have contraindications in congestive heart failure. 1, 2

Safety Profile of Skyrizi (Risankizumab)

• Risankizumab is an interleukin-23 antagonist (IL-23 inhibitor) approved for the treatment of active psoriatic arthritis in adults 2
• The most common adverse events with risankizumab are upper respiratory tract infections, headache, fatigue, and injection site reactions 2, 3
• Long-term safety data shows risankizumab is well-tolerated with a favorable safety profile for up to 4 years of treatment 4
• Unlike TNF inhibitors, risankizumab does not have specific contraindications related to cardiovascular disease, making it suitable for patients with cardiovascular comorbidities 1

Cardiovascular Safety Considerations

• Risankizumab does not carry the same cardiovascular contraindications as TNF inhibitors, which are contraindicated in congestive heart failure 1
• The American College of Rheumatology/National Psoriasis Foundation guidelines specifically note that TNF inhibitors may be contraindicated in patients with congestive heart failure, but do not list similar concerns for IL-23 inhibitors like risankizumab 1
• The incidence of major adverse cardiovascular events (MACE) with IL-23 inhibitors is low, with no evidence of increased cardiovascular risk 3, 4

Comparison with Previous Treatment (Taltz/Ixekizumab)

• Ixekizumab (Taltz), an IL-17 inhibitor, has shown low rates of major adverse cardiovascular events (MACE) in long-term safety studies (IR 0.5/100 patient-years) 5, 6
• The switch from ixekizumab to risankizumab due to oral candidiasis was appropriate, as IL-17 inhibitors are associated with increased risk of mucocutaneous Candida infections 1, 7
• Integrated safety analyses of ixekizumab showed that Candida infections were among the most common opportunistic infections reported 7, 6

Specific Guidance for Concomitant Medications

• Risankizumab can be administered alone or in combination with non-biologic disease-modifying antirheumatic drugs (DMARDs) 2
• No specific drug interactions between risankizumab and cardiovascular medications have been reported in clinical trials or post-marketing surveillance 2, 3
• Topical corticosteroids can be safely used alongside risankizumab without concerns for drug interactions 1

Important Monitoring Considerations

• Before initiating risankizumab for inflammatory bowel disease, liver enzymes and bilirubin levels should be obtained, though this is not specifically required for psoriatic arthritis 2
• Complete all age-appropriate vaccinations before starting treatment, as live vaccines should be avoided during risankizumab therapy 2
• Monitor for signs of infection, as risankizumab may increase infection risk, though serious infections are uncommon 2, 3

Treatment Algorithm for Psoriatic Arthritis

• For patients who have failed an IL-17 inhibitor like ixekizumab (Taltz), switching to an IL-23 inhibitor like risankizumab (Skyrizi) is appropriate, especially when the reason for discontinuation was Candida infection 1
• A full 3-month trial period is recommended to properly assess efficacy of biologics like risankizumab 8
• If inadequate response occurs after 3 months, consider switching to a TNF inhibitor, unless contraindicated due to cardiovascular disease or recurrent infections 1, 8

Potential Pitfalls to Avoid

• Avoid premature discontinuation of risankizumab therapy, as clinical response should be evaluated after at least 12 weeks 8
• Do not administer live vaccines during risankizumab treatment 2
• Be vigilant for signs of hypersensitivity reactions, which are rare but can occur with risankizumab 2