Risankizumab vs. ustekinumab for plaque psoriasis

Psoriasis is a skin condition that causes a scaly, red rash which can vary from affecting only small areas of the body, such as the elbows and knees, to affecting a larger area of the body. It affects approximately 2% of people in the U.K. There are many treatments for psoriasis, including creams, tablets and injections. The injections are known as biologics and these target specific parts of the immune system that can be very active in psoriasis. The authors of this paper, based in the U.K., aimed to assess the quality of two trials (called UltIMMa‐1 and UltIMMa‐2) that compared two of these biologics, risankizumab and ustekinumab. These trials included patients from 14 countries, and showed that risankzizumab is more effective than ustekinumab for treating patients with moderate or severe psoriasis. The authors found that these trials were well‐conducted because they recruited a large number of patients and the methods used were sound and clearly reported. They analysed the data in a way which is conservative and doesn't over‐estimate the effect of the new treatment, risankizumab. One criticism of the trials is that it could be difficult to apply the results to some groups of patients in the clinical setting (i.e. in real life treatment rather than in a trial). For example, it's not clear whether patients who have failed tablet or some other injection treatments would respond differently from those who have never had such treatments. Additionally, some patients with other illnesses were excluded from the study, though it was not specified which illnesses lead to exclusion. The authors conclude that this study does clearly demonstrate that risankizumab is more effective than ustekinumab, though more work needs to be done to identify why this is the case.