Real-World Data on Risankizumab and Psoriatic Arthritis Prevention in Psoriasis

In this discussion, Saakshi Khattri, MD, a rheumatologist and dermatologist at the Icahn School of Medicine at Mount Sinai, reviews emerging real-world evidence on risankizumab in psoriatic disease, with a focus on psoriatic arthritis (PsA) prevention. She notes that for clinicians managing patients with psoriasis, the possibility of reducing PsA risk is a central concern, yet prospective prevention trials directly comparing mechanisms of action (MOAs) are lacking. In this context, real-world comparative effectiveness data have become an important—albeit imperfect—source of insight.

Khattri explains that analyses of real-world datasets suggest patients with psoriasis treated with risankizumab are less likely to develop PsA than those receiving other targeted immunomodulators. She emphasizes that these findings are based on observational claims and registry data, not on prospective prevention trials, and therefore must be interpreted cautiously.

Nonetheless, in the absence of randomized data, she considers “any data better than no data,” particularly when it consistently signals a lower incidence of PsA in association with IL-23 inhibition.

From a mechanistic standpoint, Khattri points out that IL-23 is a key upstream cytokine implicated in both cutaneous and joint inflammation in psoriatic disease. Blocking IL-23 may therefore be biologically plausible as a strategy to blunt progression from skin-only psoriasis to PsA.

While she underscores that these findings do not establish proof of prevention, she reports that this emerging signal influences her systemic therapy selection for patients who currently have psoriasis alone but are at risk for future PsA.