MedZora Article

Risankizumab, a medication that blocks a protein called interleukin‑23 (IL‑23), has recently been studied in people with moderate‑to‑severe ulcerative colitis (UC). After showing promise in Crohn's disease, the phase 3 COMMAND trial explored whether it could help patients who have not responded well to anti‑TNF drugs. The results suggest that risankizumab may become another option for managing this chronic condition, but they also highlight that treatment decisions must remain individualized.
Why this matters

Ulcerative colitis is a long‑lasting inflammation of the colon that can cause abdominal pain, frequent diarrhea and rectal bleeding. For many patients, the first line of therapy includes anti‑TNF agents such as infliximab or adalimumab. However, a sizable proportion of people either do not achieve remission or lose response over time. Introducing a drug that works through a different biological pathway offers a potential route for those who have exhausted other options.
What the research shows

The COMMAND trial enrolled adults with moderate‑to‑severe UC who had active disease despite stable anti‑TNF therapy or who could not tolerate those drugs. Participants were randomly assigned to receive risankizumab or placebo for a 12‑week induction phase, followed by a maintenance phase up to week 52.
- Induction results: At week 12, a higher proportion of patients receiving risankizumab achieved clinical remission (defined as a Mayo score ≤ 2 with no subscore > 1) compared with placebo. The difference was statistically significant, although some patients in the placebo group also reached remission, reflecting the natural variability of the disease.
- Endoscopic improvement: Endoscopic assessments showed that risankizumab recipients were more likely to have a cleared or nearly cleared colon lining (Mayo endoscopic subscore 0‑1) than those on placebo. Endoscopic healing is associated with lower relapse rates, but the trial did not follow patients long enough to confirm sustained benefits beyond one year.
- Maintenance outcomes: By week 52, patients who continued risankizumab maintained higher remission rates than those who switched to placebo. The safety profile remained comparable, with the most common adverse events being mild infections and headache; serious infections were rare but still observed in a small number of participants.

The investigators concluded that targeting IL‑23 can produce meaningful clinical and endoscopic improvements in UC. Nevertheless, they cautioned that longer‑term data and head‑to‑head comparisons with other biologics are still needed.
How it may affect clinical practice

If risankizumab receives regulatory approval for UC in the UAE, gastroenterologists may consider it for patients who:
- Have moderate‑to‑severe disease activity despite optimized anti‑TNF therapy.
- Experience intolerance or contraindications to other biologics such as vedolizumab or ustekinumab.
- Prefer a dosing schedule that involves less frequent injections after the initial induction phase (risankizumab is typically administered every 12 weeks after induction).

Because risankizumab works on a different part of the immune system, it could be used after anti‑TNF failure without the same risk of cross‑reactivity. However, insurance coverage and cost considerations may influence accessibility, and clinicians will still need to assess infection risk, vaccination status and comorbidities before starting therapy.
Practical takeaways for patients

If your doctor mentions risankizumab as a possible option, you might ask the following questions:

1. Why is this medication being considered for me? Understanding whether you have failed previous biologics helps clarify the rationale.
2. What are the expected benefits and what does "remission" mean for me? Remission generally means fewer symptoms and an improved colon appearance on endoscopy, but individual goals can vary.
3. What are the common side effects and how will they be monitored? Mild infections are the most frequent, and regular blood tests may be recommended.
4. How will the treatment schedule fit into my life? After the first few doses given at weeks 0, 4 and 12, maintenance injections are usually spaced every 12 weeks.
5. What alternatives exist if this therapy does not work? Discuss other biologic classes or small‑molecule options that might be appropriate.

Staying engaged with your gastroenterology team, keeping a symptom diary, and attending scheduled colonoscopies can help you and your clinician evaluate whether the medication is meeting its targets.
Key takeaways
- Risankizumab targets IL‑23, offering a different mechanism from anti‑TNF drugs.
- The COMMAND phase 3 trial showed higher induction and maintenance remission rates compared with placebo.
- Endoscopic healing was more common with risankizumab, which may translate to longer‑term disease control.
- Safety findings were similar to placebo, with mild infections as the most frequent adverse event.
- The drug may be considered for patients with moderate‑to‑severe UC who have not responded to or cannot tolerate anti‑TNF therapy.
- Long‑term efficacy and direct comparisons with other biologics are still under investigation.

This article provides general information and does not replace personal medical advice. Please discuss any treatment decisions with your own clinician.