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Ixekizumab: Comparison With Risankizumab in Psoriasis
No head-to-head data comparing ixekizumab with risankizumab are available. Indirect comparison analyses are provided below.
Ixekizumab is a humanized IgG4 mAb that selectively binds with the IL-17A cytokine and inhibits its interaction with the IL-17 receptor. IL-17A is a naturally occurring cytokine involved in normal inflammatory and immune responses. Ixekizumab inhibits the release of proinflammatory cytokines and chemokines.1
No head-to-head trials have been conducted comparing the efficacy and safety of ixekizumab to that of risankizumab in the treatment of psoriasis.
Since clinical trials are conducted under widely varying and controlled conditions, efficacy outcomes and adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Risankizumab-rzaa is a humanized IgG1 mAb that selectively binds to the p19 subunit of the human IL-23 cytokine and inhibits its interaction with the IL-23 receptor. IL-23 is a naturally occurring cytokine that is involved in inflammatory and immune responses. Risankizumab-rzaa inhibits the release of proinflammatory cytokines and chemokines.2
Adjusted Indirect Comparison of Ixekizumab and Risankizumab in Plaque Psoriasis
The methodology used to indirectly compare the primary efficacy outcomes (PASI 75 and PASI 90) of ixekizumab and risankizumab in patients with moderate-to-severe psoriasis were
AIC using the Bucher method, and
MAIC using the Signorovitch method, which is an extension of AIC taking into account differences in baseline characteristics and/or treatment effect modifiers matched to the means of the characteristics available in the literature.3
Both methods of indirect comparisons used are subject to limitations including the potential for bias due to differences between trial populations and imbalances in unobserved factors between trials. These limitations can only be avoided with head-to-head randomized trials.4,5
The authors concluded that indirect comparison across multiple analysis methods using a placebo comparator bridge indicated that ixekizumab provides clinical benefits over risankizumab in terms of PASI 75 and PASI 90 response and with regard to speed of action up to week 12 in patients with moderate-to-severe psoriasis.3
In the ustekinumab bridge, efficacy analysis was performed on a smaller sample size (256 unmatched ixekizumab-treated patients compared to 1952 unmatched ixekizumab-treated patients in the placebo bridge) which may have led to less precise results.3
1Taltz [package insert]. Indianapolis, IN: Eli Lilly and Company; 2021.
2SKYRIZI [package insert]. North Chicago, IL: AbbVie Inc; 2019.
3Gottlieb A, Ramot Y, Smith S, et al. Indirect comparison of ixekizumab versus risankizumab for up to 12 weeks of treatment in patients with moderate-to-severe psoriasis. Poster presented at: 77th Annual Meeting of the American Academy of Dermatology; March 1-5, 2019; Washington, DC. https://www.aad.org/eposters/Submissions/getFile.aspx?id=9775&type=sub
4Bucher HC, Guyatt GH, Griffith LE, et al. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol 1997;50(6):683-691. https://doi.org/10.1016/S0895-4356(97)00049-8
5Signorovitch JE, Wu EQ, Yu AP, et al. Comparative effectiveness without head-to-head trials: a method for matching-adjusted indirect comparisons applied to psoriasis treatment with adalimumab or etanercept. Pharmacoeconomics.2010;28(10):935-945. http://dx.doi.org/10.2165/11538370-000000000-00000
AIC = adjusted indirect comparison
IgG1 = immunoglobulin G subclass 1
IgG4 = immunoglobulin G subclass 4
IL = interleukin
mAb(s) = monoclonal antibody
MAIC = matched-adjusted indirect comparison
PASI = Psoriasis Area and Severity Index
PASI 75 = 75% improvement from baseline in Psoriasis Area and Severity Index
PASI 90 = 90% improvement from baseline in Psoriasis Area and Severity Index
Fecha de la última revisión:2019 M08 13
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