This matching-adjusted indirect comparison (MAIC) evaluated the relative efficacy of risankizumab (injectable IL-23 inhibitor) versus icotrokinra (oral IL-23 receptor blocker) in adults with moderate-to-severe plaque psoriasis through week 52, using individual patient data from phase 3 risankizumab trials and published summary data from icotrokinra phase 3 trials (ICONIC-ADVANCE 1 & 2).
At week 16, placebo-adjusted response rates significantly favored risankizumab over icotrokinra across all endpoints: PASI 75 (80.6% vs 61.7%; RD +18.9%, 95% CI 11.5–26.4; P<0.001), PASI 90 (71.4% vs 49.9%; RD +21.5%, 95% CI 15.6–27.4; P<0.001), PASI 100 (42.3% vs 29.4%; RD +13.0%, 95% CI 7.9–18.0; P<0.001), IGA 0/1 (77.8% vs 58.4%; RD +19.4%; P<0.001), and IGA 0 (41.6% vs 33.9%; RD +7.7%; P<0.05); differences were consistent through week 52.
- No head-to-head trial exists; MAIC relies on cross-trial assumptions that may not fully account for unmeasured confounders. - Unanchored analyses at weeks 24 and 52 lack a shared placebo arm, increasing potential for residual bias. - The study was funded by the risankizumab manufacturer (AbbVie/J&J sponsorship context), introducing industry conflict of interest.
When choosing between an injectable IL-23 inhibitor (risankizumab) and the new oral IL-23 receptor blocker (icotrokinra) for moderate-to-severe plaque psoriasis, this indirect comparison suggests risankizumab achieves meaningfully higher skin clearance rates at all time points through one year. Clinicians should weigh this efficacy gap against patient preference for an oral therapy, bearing in mind the inherent limitations of cross-trial comparisons.
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