A NEW exploratory study highlights the value of optical coherence tomography (OCT) in assessing long-term treatment effects of risankizumab in patients with moderate-to-severe psoriasis, revealing improvements beyond what is visible on clinical examination alone.
Psoriasis is a chronic inflammatory condition associated with systemic comorbidities and impaired quality of life. While established clinical scores such as the Psoriasis Area and Severity Index (PASI), Investigator’s Global Assessment (IGA), and Body Surface Area (BSA) effectively measure visible disease activity, they may fail to capture persistent subclinical inflammation. Risankizumab, a selective interleukin-23 inhibitor, has demonstrated robust clinical efficacy, but its impact on deeper structural and vascular changes in the skin has remained less well defined.
Optical Coherence Tomography in Psoriasis Monitoring
This prospective, single-centre sub-analysis included 22 patients with moderate-to-severe psoriasis treated with risankizumab for up to 52 weeks. Clinical outcomes were assessed at regular intervals, while OCT imaging was performed at baseline and weeks 4, 16, and 52. OCT enabled non-invasive, real-time evaluation of epidermal thickness and vascular parameters, including vessel density and diameter, in both lesional and perilesional skin.
Risankizumab Demonstrates Sustained Psoriasis Control
Clinical responses were rapid and sustained. By week 16, mean PASI scores decreased significantly from 16.3 at baseline to 3.5, accompanied by a reduction in mean BSA involvement from 24.7% to 5.2% (both p<0.001). At week 52, 86.7% of patients achieved PASI 75, 73.3% achieved PASI 90, and 40.0% achieved complete skin clearance (PASI 100). Additionally, 93.3% of patients reached an IGA score of 0 or 1.
Importantly, OCT imaging demonstrated marked reductions in epidermal thickness (−37.4%), vessel density (−26.6%), and vessel diameter (−59.5%) in lesional skin over the 52-week period. Notably, vascular improvements were also observed in perilesional skin that appeared clinically uninvolved, suggesting a reduction in subclinical inflammation.
Assessing Long-Term Psoriasis Outcomes with OCT
The authors conclude that risankizumab provides sustained clinical and microstructural benefits in psoriasis, supporting the importance of long-term therapy. OCT emerged as a valuable adjunctive tool for evaluating deep treatment responses, offering a more comprehensive understanding of disease activity and therapeutic outcomes beyond visible skin clearance.
Reference
Zirpel H et al. Evaluating Risankizumab’s Long-Term Effects in Psoriasis Using Optical Coherence Tomography. Dermatol Ther (Heidelb). 2026;doi: 10.1007/s13555-025-01637-2.
