Risankizumab in Psoriasis: Real-World Effectiveness, Safety, and Clinical Outcomes

Abstract

Background Risankizumab (anti–IL-23 p19) is an established therapy for moderate-to-severe psoriasis, with strong trial efficacy and growing real-world evidence. However, long-duration outcomes and treatment-spacing patterns from the Gulf region remain limited. Objective To evaluate long-term effectiveness, safety, and treatment patterns—including extended-interval dosing—of Risankizumab in a real-world tertiary center. Methods Single-center retrospective cohort of adults treated with Risankizumab between January 2020 and January 2025. Primary outcome: Psoriasis Area and Severity Index (PASI) 100 on last visit. Secondary outcomes: changes in Psoriasis Area and Severity Index (PASI), body surface area (BSA), and Dermatology Life Quality Index (DLQI) and Nail Psoriasis Severity Index (NAPSI); adverse events; treatment persistence and dosing intervals. Non-parametric tests were used; predictors of PASI 100 were explored with multivariable logistic regression. Results We included 144 patients (mean age 39.3±14.9 years; 55.6% male; mean BMI 29.0±6.5). At last visit, 61.1% achieved PASI 100. Mean scores improved from baseline to last visit: PASI 7.24→0.34, BSA 9.81%→0.26%, DLQI 7.64→0.68, NAPSI 9.56→2.94 (all p<0.001). Adverse events were infrequent (3.5%), all mild; no major adverse cardiovascular events or deaths occurred. A single case of lung cancer was reported and considered unlikely to be treatment related. A quarter of patients transitioned to extended intervals (most commonly every 4–6 months), with the majority maintaining disease control and relapse occurring infrequently and only after ≥6 months. Longer treatment duration and maintenance of standard dosing frequency were associated with achieving PASI 100, while positive family history was associated with lower odds of complete clearance. Conclusion In routine practice, Risankizumab achieved high complete-clearance rates with excellent tolerability over ~31 months’ mean exposure. Extended-interval dosing was feasible in selected stable responders. These findings align with trial durability and regional registry signals and support individualized long-term strategies.