A Study Comparing Risankizumab to Placebo in Participants With Active Psoriatic Arthritis Including Those Who Have a History of Inadequate Response or Intolerance to Biologic Therapy(Ies) (KEEPsAKE2)

Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria:

1. ≥ 20% improvement in 68-tender joint count;
2. ≥ 20% improvement in 66-swollen joint count; and

3. ≥ 20% improvement in at least 3 of the 5 following parameters:

   • Physician global assessment of disease activity
   • Patient global assessment of disease activity
   • Patient assessment of pain
   • Health Assessment Questionnaire - Disability Index (HAQ-DI)
   • High-sensitivity C-reactive protein (hsCRP).

The Health Assessment Questionnaire Disability Index is a patient-reported questionnaire that measures the degree of difficulty a person has in accomplishing tasks in 8 functional areas (dressing, arising, eating, walking, hygiene, reaching, gripping, and errands and chores) over the past week. Participants assessed their ability to do each task on a scale from 0 (without any difficulty) to 3 (unable to do). Scores were averaged to provide an overall score ranging from 0 to 3, where 0 represents no disability and 3 represents very severe, high-dependency disability.

A negative change from Baseline in the overall score indicates improvement.

PASI is a composite score based on the percentage of the body surface area (BSA) affected by psoriasis and the intensity of erythema (reddening), induration (thickening or hardening of the skin), and desquamation (peeling of the skin) of lesions assessed at 4 anatomic sites (head, upper extremities, trunk, and lower extremities). At each location, the percentage of BSA involvement is assigned a score from 0 (no involvement) to 6 (90% to 100% involvement), and erythema, induration, and desquamation are scored on a scale from 0 (no symptoms) to 4 (very marked).

The PASI score ranges from 0 (no psoriasis) to 72 (very severe psoriasis). A PASI 90 response is the percentage of participants who achieved at least a 90% reduction (improvement) from Baseline in PASI score.

Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria:

1. ≥ 20% improvement in 68-tender joint count;
2. ≥ 20% improvement in 66-swollen joint count; and

3. ≥ 20% improvement in at least 3 of the 5 following parameters:

   • Physician global assessment of disease activity
   • Patient global assessment of disease activity
   • Patient assessment of pain
   • Health Assessment Questionnaire - Disability Index (HAQ-DI)
   • High-sensitivity C-reactive protein (hsCRP).

A participant was classified as achieving MDA if 5 of the following 7 criteria were met:

• Tender joint count (out of 68 joints) ≤ 1
• Swollen joint count (out of 66 joints) ≤ 1
• PASI score ≤ 1 (score ranges from 0 - 72) or percent BSA involved with psoriasis ≤ 3%
• Patient's assessment of pain ≤ 15 (VAS from 0 to 100)
• Patient's Global Assessment of disease activity ≤ 20 (VAS from 0 to 100)
• HAQ-DI score ≤ 0.5 (index score ranges from 0 to 3)
• Leeds Enthesitis Index ≤ 1 (assesses the presence or absence of enthesitis at 3 bilateral sites, for an overall score range from 0 to 6)

The Short Form 36-Item Health Survey (SF-36) Version 2 is a self-administered questionnaire that measures the impact of disease on overall quality of life during the past 4 weeks. The SF-36 consists of 36 questions in eight domains (physical function, pain, general and mental health, vitality, social function, physical and emotional health).

The physical component summary is a weighted combination of the 8 subscales with positive weighting for physical functioning, role-physical, bodily pain, and general health. The SF-36 PCS ranges from 0 to 100. A linear algorithm was applied to the calculation of the PCS which has a normative mean value of 50. Higher scores are associated with less disability; a score of 100 is equivalent to no disability and a score of 0 is equivalent to maximum disability. A positive change from Baseline score indicates improvement.

Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR50 response criteria:

1. ≥ 50% improvement in 68-tender joint count;
2. ≥ 50% improvement in 66-swollen joint count; and

3. ≥ 50% improvement in at least 3 of the 5 following parameters:

   • Physician global assessment of disease activity
   • Patient global assessment of disease activity
   • Patient assessment of pain
   • Health Assessment Questionnaire - Disability Index (HAQ-DI)
   • High-sensitivity C-reactive protein (hsCRP).

Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR70 response criteria:

1. ≥ 70% improvement in 68-tender joint count;
2. ≥ 70% improvement in 66-swollen joint count; and

3. ≥ 70% improvement in at least 3 of the 5 following parameters:

   • Physician global assessment of disease activity
   • Patient global assessment of disease activity
   • Patient assessment of pain
   • Health Assessment Questionnaire - Disability Index (HAQ-DI)
   • High-sensitivity C-reactive protein (hsCRP).

Resolution of enthesitis is defined as a Leeds Enthesitis Index (LEI) score = 0.

LEI is an enthesitis measure developed specifically for PsA and assesses the presence or absence of tenderness at the following 3 bilateral enthesial sites: medial femoral condyles, lateral epicondyles of the humerus, and Achilles tendon insertions. Tenderness on examination is recorded as either present (coded as 1), absent (coded as 0), or not assessed for each of the 6 sites. The LEI is calculated by taking the sum of the scores from the 6 sites. The LEI ranges from 0 to 6 (worst).

Resolution of dactylitis is defined as a Leeds Dactylitis Index (LDI) score = 0.

The LDI basic is a score based on finger circumference and tenderness, assessed across all digits. The LDI basic measures the ratio of the circumference of the affected digit to the circumference of the digit on the opposite hand or foot, using a minimum difference of 10% to define a dactylitic digit. The ratio of circumference is multiplied by a tenderness score (1 for tender, 0 for non-tender). If both sides of a digit are considered involved, or the circumference of the contralateral digit cannot be obtained, a standard reference table is used.

Scores from each digit are summed to provide the final LDI. A higher LDI indicates worse dactylitis.