Greater Guselkumab Response More Likely Among Younger, Less Obese Psoriasis Patients

Patients with psoriasis who were younger, less obese and had less severe psoriasis were more likely to achieve complete skin clearance from treatment with guselkumab, a monoclonal antibody targeting interleukin 23, a recent study found.

The study was a post-hoc analysis of pooled data from VOYAGE-1 and VOYAGE-2 studies. Out of 664 participants included in the analysis, 271 achieved super-response, which is defined by a Psoriasis Area and Severity Index (PASI) 100 response at weeks 20 and 28.

“Although most patients with moderate-to-severe psoriasis receiving biologics will require continuous long-term treatment due to the chronic nature of their disease, data from this post hoc analysis suggest that guselkumab-treated patients with super-response have distinguishable baseline demographic and disease characteristics,” the authors, led by Kristian Reich, MD, PhD (equivalent), of University Medical Center Hamburg-Eppendorf in Germany, wrote.

“These results may allow clinicians to predict which patients at their baseline might achieve super-response, which may be beneficial in drug selection, managing patient expectations of treatment response, and improving patient-physician communication; however, the clinical relevance of these findings requires further study.”

The study used a stepwise logistic regression analysis to evaluate which factors were potentially predictive of super-response. Patients who achieved super-response compared with those with non-super-response were:

• Lighter, with a median body weight of 187 pounds vs 198 pounds
• Less obese, with a BMI of 30 or above among 35.4% vs 45.3%
• Had lower baseline IGA scores of 4 among 16.2% vs. 26.5%
• Less likely to have nail psoriasis, 49.1% vs 64.9%
• Less previous use of systemic non-biologic treatments, 60.9% vs 69%
• Less likely to have metabolic syndrome at baseline, 19.9% vs 25.4%

Factors that were similar between the two groups included diabetes mellitus and hypertension, cigarette use, and baseline blood pressure, fasting glucose, and lipid levels.

“Based on the stepwise logistic regression model, only patient age at study entry, baseline body weight (≤90 kg vs >90 kg), baseline PASI, and baseline IGA score were significant predictors of super-response status,” the authors wrote.

Patients who achieved super-response were more likely to demonstrate early clinical responses, with 5.5% demonstrating a PASI 75 response as early as Week 2 compared with 1.8% of those with non-super-response. PASI 90 was achieved as early as Week 4 among 10% of those who achieved super-response versus 3.6% of those who didn’t, and PASI 100 was achieved as early as Week 8 among 22.5% versus 3.3%.

Limitations of the study include that it is a post hoc analysis with a relative small number of patients, super-response was only evaluated through Week 28 and super-response status was not analyzed for the adalimumab comparator group.

Guselkumab is the first IL-23 inhibitor approved for adults with psoriasis.

A recent study found that guselkumab was associated with longer adherence and greater proxy remission rates than other biologic therapies, including adalimumab, secukinumab and ixekizumab.

Another recent study found that guselkumab was well tolerated and efficacious in patients with moderate to severe psoriasis regardless of previous biologic therapies, comorbidities or psoriasis manifestation in difficult-to-treat areas. The interleukin 23 biologic also was associated with sustained tolerability and consistent psoriasis clearance over five years.

“The availability of new biologics approved for psoriasis now makes achievement of clear skin a pragmatic treatment goal,” the study authors wrote. “Guselkumab, a first-in-class novel IL-23 p19 inhibitor, is effective and safe in the treatment of patients with moderate-to-severe plaque psoriasis, and complete clearance can be obtained in a significant proportion of patients.”

The study, "Super-Response to Guselkumab Treatment in Patients With Moderate-to-Severe Psoriasis: Age, Body Weight, Baseline Psoriasis Area and Severity Index, and Baseline Investigator’s Global Assessment Scores Predict Complete Skin Clearance," was published online in Journal of the European Academy of Dermatology and Venerology.