Risankizumab (Rheumatology)

How it works

It selectively binds the p19 subunit of interleukin-23, inhibiting IL-23 signalling and the downstream Th17 inflammatory pathway that drives psoriatic skin and joint disease.

Prescribing in practice

• Exclude active infection, including active tuberculosis, before starting and screen for latent TB, treating it before therapy as a key safety step.
• Avoid live vaccines during treatment and update immunisations beforehand where possible.
• Hypersensitivity reactions can occur, and patients should be monitored for new or worsening infection during treatment.

Monitoring

Monitor clinically for infection and for treatment response, with tuberculosis status reviewed before and as indicated during therapy.

Counselling the patient

• Report signs of infection that are severe or persistent.
• It is given as a subcutaneous injection and self-injection can be taught.
• Tell us about planned vaccinations so timing can be advised.

Evidence & guidelines

Use in psoriatic arthritis is supported by randomised controlled trials showing significant improvement in joint and skin outcomes.