OBJECTIVES: Psoriasis (PsO) is a chronic inflammatory disease associated with pain and disability that negatively impacts health-related quality of life. Biologics can be used to treat moderate-to-severe PsO, but there is a lack of long-term head-to-head comparisons between newer classes of biologics including interleukin-23 inhibitors. This study aimed to indirectly compare guselkumab and risankizumab with respect to percentage improvement from baseline in the Psoriasis Area and Severity Index (PASI) score in patients with moderate-to-severe PsO.

METHODS: Individual patient-level data from two phase 3 randomized trials for guselkumab (VOYAGE 1 and ECLIPSE) and pooled summary-level data from two phase 3 randomized trials for risankizumab (UltIMMa-1 and UltIMMa-2) were analyzed. An unanchored matching-adjusted indirect comparison (MAIC) was conducted by re-weighting the patients from the guselkumab trials on 9 clinically-relevant characteristics to match baseline characteristics reported for the risankizumab trials. The relative efficacy of percentage change from baseline in PASI from weeks 4 through 40 was examined. Sensitivity analyses were conducted exploring alternative adjustment variables likely to have an impact on treatment effect.

RESULTS: An initial sample of 862 patients treated with guselkumab was reduced to an effective sample size of 503 after matching and adjustment. The mean difference between guselkumab and risankizumab in change from baseline in PASI score decreased over time with differences at 4, 16, and 40 weeks of 4.24 (95%CI, 1.58 to 6.91), 2.89 (95%CI, 0.68 to 5.1), and 0.32 (95%CI, -1.93 to 2.57), respectively. Confidence intervals were large relative to the size of the estimated effect at all time points. Results were consistent across all sensitivity analyses.

CONCLUSIONS: Guselkumab and risankizumab offer comparable efficacy in improvement in PASI score. Lower and upper bounds of confidence intervals generally captured small benefit, suggesting differences between therapies are not likely to be clinically meaningful.