Predicting Psoriasis "Super Responders": New Real-World Data on Durability of Risankizumab

The concept of “super responders” (SRs)—patients who achieve rapid, complete, and sustained skin clearance—has emerged as a clinically meaningful phenotype in psoriasis, with potential implications for treatment sequencing and long-term disease control.¹ In this large, multicenter, international real-world study, investigators evaluated the prevalence, predictors, and durability of SR status among patients with moderate to severe plaque psoriasis treated with risankizumab.²

“Identifying patients who are likely to achieve such responses could optimize treatment sequencing, minimize unnecessary therapeutic switches, and support individualized therapeutic strategies,” the study authors noted.

Methods and Materials

This retrospective observational analysis included 1372 adult patients from 10 referral centers in Italy and Portugal. All patients had received risankizumab for at least 20 weeks. SRs were defined as those achieving complete skin clearance (Psoriasis Area and Severity Index [PASI] score, 0) at week 20. Maintenance of PASI 0 was assessed longitudinally through week 52 and up to 2.5 years (130 weeks). Multivariate logistic regression models were used to identify predictors of both SR achievement and long-term maintenance.

At baseline, patients had a mean PASI score of 14.9 and a mean disease duration of 18.2 years. Approximately 61% were biologic naive, whereas 39% had prior biologic exposure. Difficult-to-treat areas were common, including scalp (49.6%), nail (25.6%), and palmoplantar (18.7%) involvement. Additionally, 19.4% had concomitant psoriatic arthritis (PsA).

Efficacy Results

Overall, risankizumab demonstrated rapid and sustained effectiveness. Mean PASI decreased to 1.5 at week 20 (P < .0001) and remained low through 2.5 years (0.6-0.7 across later time points). At week 20, 610 of 1372 patients (44.5%) achieved PASI 0 and were classified as SRs. The overall proportion of patients achieving PASI 0 increased over time, reaching 66.6% at week 52 and remaining above 60% through 2.5 years.

Durability of early complete clearance was notable. Among week-20 SRs, 84.4% maintained PASI 0 at week 52, 71.8% at 2 years, and 64.9% at 2.5 years. Importantly, a substantial proportion of initial non-SRs achieved complete clearance with continued treatment: 52.0% at week 52 and 43.5% at 2.5 years. These findings underscore both the early potency and sustained effectiveness of IL-23 inhibition with risankizumab.

Rate of Super Responders

Predictive modeling identified biologic-naive status as the strongest and most consistent predictor of SR achievement (OR, 1.65; P < .001). Conversely, palmoplantar psoriasis (OR, 0.58; P = .005) and higher body mass index (BMI) (OR, 0.96 per unit increase; P = .011) were independently associated with a lower likelihood of achieving PASI 0 at week 20.

Among week-20 SRs, biologic-naive status also strongly predicted maintenance of complete clearance at week 52 (OR, 2.09; P = .005), 2 years (OR, 2.12; P = .012), and 2.5 years (OR, 2.87; P = .003). Palmoplantar involvement negatively influenced maintenance at earlier time points, whereas PsA was associated with reduced persistence at 2 years (OR, 0.56; P = .049). Interestingly, higher baseline PASI modestly predicted sustained PASI 0 at certain time points, suggesting that patients with more inflammation-driven disease may derive particularly durable benefit from IL-23 blockade. At 2.5 years, older age was inversely associated with maintenance (OR, 0.98; P = .038).

Overall discontinuation rates were low (8.4%). The most common reason was loss of efficacy (3.2%), followed by loss to follow-up (3.2%). Discontinuation due to adverse events was rare (0.3%), and no new safety signals emerged, supporting the favorable long-term safety profile observed in clinical trials and prior real-world studies.

Conclusion

Overall, these new data confirm that risankizumab induces rapid, complete skin clearance in nearly half of treated patients by week 20 and that this response is durable in the majority for over 2.5 years. Biologic-naive patients—particularly those without palmoplantar disease and with lower BMI—appear most likely to achieve and maintain SR status. These findings reinforce the potential value of earlier IL-23 inhibition in therapeutic sequencing and support the concept of a distinct SR phenotype characterized by deep and sustained remission under risankizumab therapy. According to the authors, future research with molecular and immunologic biomarkers should further analyze the mechanisms underlying this unique responder profile.

References

1. Thomas SE, van den Reek JMPA, Seyger MMB, de Jong EMGJ. How to define a 'super-responder' to biologics in psoriasis studies. Br J Dermatol. 2023;189(5):621-622. doi:10.1093/bjd/ljad280

2. Orsini D, Potestio L, Megna M, et al. Risankizumab super responders in moderate-to-severe psoriasis: prevalence, predictors, and long-term maintenance in a multicenter, international, real-world cohort. J Dermatolog Treat. 2026;37(1):2617770. doi:10.1080/09546634.2026.2617770