What is the recommended treatment regimen for moderate to severe plaque psoriasis using Risankizumab (Risankizumab)?

Risankizumab Treatment for Moderate to Severe Plaque Psoriasis

Standard Dosing Regimen

For moderate to severe plaque psoriasis, administer risankizumab 150 mg subcutaneously at weeks 0 and 4, then every 12 weeks thereafter for maintenance therapy. 1

This dosing schedule achieves steady-state peak concentrations of approximately 12 mcg/mL and trough concentrations of 2 mcg/mL, with steady state reached by week 16. 2 The subcutaneous bioavailability is 89%, with peak plasma concentrations occurring 3-14 days after injection and a terminal half-life of approximately 28 days. 1, 3

Expected Efficacy Outcomes

• 36-45% of patients achieve complete skin clearance (PASI 100) at week 16 1
• 62.9-66.7% achieve PASI 90 response at week 16 4
• 78.1-81.5% achieve clear or almost clear skin (sPGA 0/1) at week 16 4
• Risankizumab demonstrates superior efficacy compared to ustekinumab, with 75% versus 42% achieving PASI 90 at week 12 1

Long-term data through 6 years shows maintained or improved efficacy, with 86.0% achieving PASI 90 and 54.2% achieving PASI 100 at week 304. 5

Response Assessment and Management Algorithm

Assess treatment response at 12 weeks of continuous therapy to determine definitive response. 1

For Partial Responders at 12 Weeks:

• Add topical corticosteroids 1
• Consider vitamin D analogues 1
• Consider adding methotrexate 1
• Consider ultraviolet B phototherapy 1

Pre-Treatment Requirements

Before initiating risankizumab, complete the following mandatory screening:

• Screen for active infections, tuberculosis, and malignancy 1
• Administer prophylactic vaccination against pneumococcal and influenza infections 1, 6
• Establish baseline respiratory status if respiratory comorbidities are present 1, 6
• Complete all indicated vaccinations 1

Special Population Considerations

Patients with Respiratory Comorbidities:

• Perform baseline pulmonary function testing before initiating therapy 6
• Schedule more frequent follow-up visits during initial treatment to monitor for respiratory symptoms 6
• Educate patients to promptly report increased respiratory symptoms or sputum production 6
• The presence of bronchiectasis, asthma, or past smoking history modifies risk-benefit assessment but does not contraindicate use 6

Pediatric Patients:

• Risankizumab is approved only for adults; clinical trials enrolled only adult patients 7
• For pediatric patients aged 4-17 years requiring biologic therapy, use alternative agents with established pediatric safety profiles such as etanercept or adalimumab 7

Elderly Patients:

• No dose adjustment required; exposures in patients ≥65 years are comparable to younger adults 2

Body Weight Considerations:

• No dose adjustment recommended based on body weight, despite lower plasma concentrations in higher body weight patients 2

Perioperative Management

Discontinue risankizumab approximately 3-4 half-lives (84-112 days) before elective surgery. 1

Resume risankizumab 1-2 weeks after surgery if no postoperative complications occur. 1

Administration Options

Risankizumab 150 mg can be administered via:

• Prefilled syringe (PFS) - single 1 mL injection 4
• Autoinjector (AI) - single 1 mL injection 4

Both delivery systems demonstrate high patient acceptability and successful self-administration rates, with comparable efficacy and safety profiles. 4

Safety Monitoring During Treatment

• Use caution in patients with pre-existing immunosuppression-related conditions 1, 6
• Monitor for signs of infection, particularly in patients with respiratory comorbidities 6
• Treatment-emergent adverse event rates remain low and consistent through 6 years of continuous therapy 5

Common Pitfalls to Avoid

• Do not delay vaccination until after starting therapy - complete all indicated vaccinations before initiating risankizumab 1
• Do not discontinue therapy prematurely - wait until 12 weeks to assess response before making treatment modifications 1
• Do not assume lack of efficacy in partial responders - consider augmentation strategies with topical agents or phototherapy rather than switching biologics 1
• Do not overlook tuberculosis screening - active TB must be ruled out before starting therapy 1