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TOPLINE:

Guselkumab shows early and durable improvement in joint symptoms, spinal pain, and skin clearance through 2 years in biologic-naive patients with active psoriatic arthritis (PsA), with a considerable proportion of patients achieving treatment targets.

METHODOLOGY:

• Guidelines from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recommend that PsA therapy achieves the lowest possible disease activity across GRAPPA-identified domains, while also considering the two associated conditions: Inflammatory bowel disease (IBD) and uveitis.
• This post hoc analysis of the phase 3 DISCOVER-2 trial evaluated the long-term efficacy of guselkumab (Tremfya; 100 mg) across GRAPPA-recognized domains in 493 biologic-naive patients with active PsA.
• Long-term (week 100) outcomes were compared among patients randomly assigned to receive guselkumab every 4 weeks (n = 245; mean age, 45.9 years; 58% men) or 8 weeks (n = 248; mean age, 44.9 years; 52% men); those assigned to placebo were not included in this study.
• The outcomes assessed included GRAPPA-identified domains: Peripheral arthritis, axial symptoms, enthesitis, dactylitis, and skin psoriasis (excluding nail psoriasis).
• Adverse events assessed through week 112 included the occurrence of IBD and uveitis or their exacerbation in patients with prior IBD or uveitis.

TAKEAWAY:

• By week 100, peripheral arthritis improved with a 69%-88% reduction in mean swollen and tender joint counts, skin psoriasis symptoms improved by 72%-96%, and spinal pain improved by 46%-50% across both guselkumab regimens.
• Through week 100, the 4- and 8-week dosing regimens led to enthesitis resolution in 61% and 70% of patients, respectively, and dactylitis resolution in 72% and 83% of patients, respectively.
• By week 100, the Disease Activity Index for PsA low disease activity was achieved by 62% and 59% of patients and minimal disease activity was achieved by 38% and 40% of patients receiving guselkumab every 4 weeks and every 8 weeks, respectively.
• By week 112, no case of IBD was reported among those randomly assigned to receive guselkumab; however, one case of uveitis was reported in the 8-week dosing group, which was resolved following treatment, with no change in guselkumab dosing.

IN PRACTICE:

"Given the multidomain nature of PsA, as well as the comprehensive and durable effectiveness and favorable safety profile of guselkumab shown in the current analysis, guselkumab represents an important treatment option to address key GRAPPA-recognized therapeutic goals for patients with PsA," the authors wrote.

SOURCE:

The investigation, led by Laura C. Coates, MD, PhD, of the University of Oxford, Oxford, England, was published online on March 30 in RMD Open.

LIMITATIONS:

Findings may not be generalizable as the data were obtained from a clinical trial. The analysis may not have been powered enough to detect rare safety signals. Moreover, data on nail psoriasis were not collected in the trial as part of the GRAPPA-identified domains.

DISCLOSURES:

The study was supported by Janssen Research & Development. Some of the authors declared being employees of Janssen, while some reported having financial relationships with pharmaceutical companies not associated with the submitted work.