Risankizumab for Moderate to Severe Plaque Psoriasis
Administer risankizumab 150 mg subcutaneously at weeks 0 and 4, then every 12 weeks thereafter for adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. 1
Standard Dosing Protocol
- Induction dosing: 150 mg subcutaneous injection at week 0 and week 4 2, 1
- Maintenance dosing: 150 mg subcutaneous injection every 12 weeks after the initial two doses 2, 1
- Administration route: Self-administered subcutaneous injection using prefilled pen or prefilled syringe after proper training 1
- Room temperature equilibration: Allow 30-90 minutes for prefilled pen or 15-30 minutes for prefilled syringe before injection 1
Pre-Treatment Requirements
Before initiating risankizumab, complete the following mandatory screening:
- Tuberculosis screening: Evaluate all patients for active or latent TB infection 1
- Infection assessment: Screen for active infections at baseline 2
- Malignancy screening: Assess for history of malignancy 2
- Vaccination status: Complete all age-appropriate vaccinations, including pneumococcal and influenza vaccines, before starting therapy 2, 1
- Respiratory baseline: Establish baseline respiratory status if comorbidities present 2
Efficacy Benchmarks and Response Assessment
- Week 16 efficacy: 36-45% of patients achieve complete clearance (PASI 100), with 55.9-66.7% achieving PASI 90 2, 3, 4
- Response assessment timeline: Evaluate treatment response at 12 weeks of continuous therapy to determine definitive positive or negative response 2
- Long-term efficacy: At week 304 (6 years), 86.0% maintain PASI 90 and 54.2% maintain PASI 100 with continuous treatment 5
Management of Partial Responders
For patients with partial response at 12 weeks, augment therapy with:
Comparative Efficacy
Risankizumab demonstrates superior efficacy compared to other biologics:
- vs. Ustekinumab: 75% vs. 42% achieving PASI 90 at week 12 2
- vs. Apremilast: 55.9% vs. 5.1% achieving PASI 90 at week 16 in moderate psoriasis 3
- vs. Adalimumab, secukinumab, and fumaric acid esters: Superior PASI 90 response rates demonstrated in head-to-head trials 6
Switching from Failed Therapies
- Apremilast non-responders: Among patients failing apremilast (PASI 75 non-responders at week 16), 72.3% achieved PASI 90 at week 52 after switching to risankizumab vs. 2.6% continuing apremilast 3
- Ustekinumab/adalimumab switchers: Durable and improved efficacy demonstrated after switching from these agents 6
Perioperative Management
- Pre-surgery discontinuation: Stop risankizumab approximately 3-4 half-lives (approximately 84-112 days, given 28-day half-life) before elective surgery 2
- Post-surgery resumption: Resume 1-2 weeks after surgery if no postoperative complications 2
Safety Monitoring and Contraindications
- Immunosuppression caution: Use caution in patients with pre-existing immunosuppression-related conditions 2
- Active infection: Temporarily discontinue if active infection develops 2
- Injection site selection: Avoid areas where skin is tender, bruised, erythematous, indurated, or affected by psoriasis 1
- Upper arm administration: Only healthcare professionals or caregivers may administer injections in the upper outer arm 1
Age Restrictions
- Adult-only indication: Risankizumab is FDA-approved only for adults without upper age limitations 7
- Pediatric alternatives: For patients under 18 years requiring biologic therapy, use etanercept (approved for ages 4+) or adalimumab (approved for ages 4+) instead 7
Pharmacokinetic Properties
- Bioavailability: 89% following subcutaneous administration 2
- Time to peak concentration: 3-14 days after dosing 2
- Terminal half-life: Approximately 28 days 2
Common Adverse Events
The most frequent adverse events (≥5%) include:
- COVID-19 infection 3
- Nasopharyngitis 3
- Treatment-emergent adverse events remain low and consistent through 6 years of continuous treatment 5