Risankizumab super responders in moderate-to-severe psoriasis: prevalence, predictors, and long-term maintenance in a multicenter, international, real-world cohort

Background/Objectives: The concept of super responders (SRs) has gained increasing attention in psoriasis. However, evidence focusing exclusively on risankizumab remains limited. This multicenter, international, real-world study aimed to assess the prevalence, predictors, and long-term maintenance of SR status among patients with moderate-to-severe plaque psoriasis treated with risankizumab. Methods: A retrospective observational study was conducted across 10 Italian and Portuguese referral centers. SRs were defined as patients achieving complete skin clearance (PASI 0) at week 20. Predictors of SR achievement and maintenance were assessed using multivariate logistic regression models at weeks 52, 104, and 130 (2.5 years). Results: A total of 1372 patients were included (mean PASI 14.9 ± 8.2). At week 20, 610 (44.5%) achieved PASI 0 and were classified as SRs; 84.4% maintained this status at week 52 and 64.9% at 2.5 years. Biologic-naïve status (OR 1.65; p < 0.001) predicted SR achievement, whereas palmoplantar psoriasis (OR 0.58; p = 0.005) and higher BMI (OR 0.96; p = 0.011) negatively influenced it. Biologic-naïve status remained the strongest predictor of long-term maintenance (OR 2.87; p = 0.003). Conclusions: Risankizumab demonstrated high and sustained long-term effectiveness, inducing rapid and sustained complete clearance in a substantial proportion of patients.