Effect of Risankizumab Compared With Deucravacitinib on Treatment Satisfaction Among Patients With Moderate Plaque Psoriasis: Results From the Phase 4 IMMpactful Trial

Introduction: Plaque psoriasis (PsO) is a chronic inflammatory skin condition which can negatively impact quality of life, and patient satisfaction with existing treatments is variable. Risankizumab (RZB), a humanized monoclonal antibody that inhibits the p19 subunit of interleukin-23, is approved for the treatment of moderate-to-severe PsO. This post hoc analysis evaluated treatment satisfaction with subcutaneous RZB every 12 weeks after induction versus once daily (QD) oral deucravacitinib (DEU) in patients with moderate PsO. Methods: Data were from the global Phase 4, multicenter, randomized, open-label, assessor-blinded, active comparator IMMpactful study (NCT06333860), which compared the impact of RZB versus DEU. Eligible patients were aged ≥18 years, candidates for systemic therapy, biologic-naïve, and had moderate PsO. Patients in Period A were randomized 1:2 to receive subcutaneous RZB (150 mg; Week 0 and 4) or oral DEU (6 mg; QD) for 16 weeks. In Period B (Week 16–52), patients were stratified by PsO Area and Severity Index (PASI) 90 response at Week 16 (responder [R] or non-responder [NR]) and those treated with RZB continued therapy (RZB/RZB) while those treated with DEU were re-randomized 1:1 to DEU (DEU/DEU) or RZB (DEU/RZB). Patients were administered the Treatment Satisfaction Questionnaire for Medication–9, a validated measure, which included 9 items assessing effectiveness, convenience, and global satisfaction. At Week 16 and 52, the percentage of patients reporting “very/extreme” (high) satisfaction for each item were summarized. Descriptive statistics were used to evaluate baseline characteristics and the change in high satisfaction response rates (hsRRs). Results: Of 374 patients, 131 were treated with RZB/RZB (R: 75, NR: 56), 121 with DEU/RZB (R: 31, NR: 90), and 122 with DEU/DEU (R: 29, NR: 93). Patients randomized to RZB or DEU at baseline were more likely to be male (61.1% or 63.0%) and had a mean (standard deviation) PASI score of 15.7 (4.2) or 15.3 (3.3), respectively. Both R and NR patients treated with RZB/RZB reported and maintained hsRRs (>62%) for effectiveness, convenience, and global satisfaction at Week 16 and 52. A high proportion of patients treated with DEU/DEU reported lower hsRRs from Week 16 to 52, with the largest decreases associated with effectiveness (ability to treat/prevent PsO in R [Week 16 (75.9%) vs 52 (48.3%), −27.6%]) and convenience (ease of medication use in NR [Week 16 (57.0%) vs 52 (20.4%), −36.6%]). NR patients treated with DEU/RZB reported a >30% increase in hsRRs across most categories with highest increases associated with time to medication effect (Week 16 [23.3%] vs 52 [68.9%], +45.6%) and overall satisfaction (Week 16 [37.8%] vs 52 [81.1%], +43.3%). Both R and NR patients who switched from DEU to RZB at Week 16 had increases in hsRRs at Week 52 for ease of planning medication use (R: +12.9%; NR: +6.7%). Conclusion: Patients with moderate PsO who continued or switched to RZB reported higher treatment satisfaction, including convenience measures, than those receiving continuous DEU, whose satisfaction decreased over time. This suggests that RZB may be associated with a more positive treatment experience in patients with moderate PsO than DEU.