Key Points:
Guselkumab exhibits early and enduring alleviation of joint symptoms, spinal pain, and skin afflictions over a two-year period among biologic-naive individuals with active psoriatic arthritis (PsA), with a notable portion achieving treatment objectives.
Research Methodology:
Following guidelines from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), treatment efficacy in PsA is evaluated based on achieving the lowest possible disease activity across identified domains, considering associated conditions like inflammatory bowel disease (IBD) and uveitis.
A post hoc analysis of the phase 3 DISCOVER-2 trial assessed the long-term effectiveness of guselkumab (Tremfya; 100 mg) across GRAPPA-identified domains in 493 biologic-naive patients with active PsA.
Long-term outcomes at week 100 were compared between patients randomly allocated to receive guselkumab every 4 weeks (n = 245; mean age, 45.9 years; 58% men) or every 8 weeks (n = 248; mean age, 44.9 years; 52% men); patients on placebo were excluded from this analysis.
Assessed outcomes included GRAPPA-identified domains: Peripheral arthritis, axial symptoms, enthesitis, dactylitis, and skin psoriasis (excluding nail involvement).
Adverse events through week 112, such as IBD and uveitis occurrence or exacerbation in patients with preexisting IBD or uveitis, were also evaluated.
Key Findings:
By week 100, both guselkumab dosing regimens led to significant improvement:
- Peripheral arthritis saw a 69%-88% reduction in mean swollen and tender joint counts.
- Skin psoriasis symptoms improved by 72%-96%.
- Spinal pain ameliorated by 46%-50%.
- Enthesitis resolution was observed in 61%-70% of patients, and dactylitis resolution in 72%-83%.
- 62% and 59% of patients achieved Disease Activity Index for PsA low disease activity, while 38% and 40% attained minimal disease activity with guselkumab every 4 weeks and every 8 weeks, respectively.
By week 112, no cases of IBD were reported among guselkumab recipients. However, one incident of uveitis occurred in the 8-week dosing group, promptly resolved with treatment, without necessitating alteration in guselkumab dosing.
Clinical Implications:
The comprehensive and enduring efficacy coupled with a favorable safety profile of guselkumab underscores its significance as a treatment option for addressing key therapeutic goals recognized by GRAPPA for PsA patients.
Study Source:
Led by Laura C. Coates, MD, PhD, of the University of Oxford, England, the investigation was published online on March 30 in RMD Open.
Study Limitations:
Generalizability may be limited as data were derived from a clinical trial. The study might lack adequate power to detect rare safety signals. Furthermore, nail psoriasis data were not captured in the trial within the GRAPPA-identified domains.
Financial Disclosures:
Janssen Research & Development supported the study. Some authors disclosed their employment with Janssen, while others reported financial ties with pharmaceutical companies not associated with the submitted work.
