Guselkumab Alleviates Pain in Patients with Psoriatic Arthritis

Peter Nash, MD, FRACP, MBBS

A team of investigators led by Peter Nash, MD, FRACP, MBBS, Griffith University, conducted 2 randomized, controlled clinical trials that focused on patients with psoriatic arthritis (PsA).

The study, “Guselkumab (Tremfya) Provides Consistent and Durable Pain Improvement in Patients with Active Psoriatic Arthritis: Results of 2 Phase 3, Randomized, Controlled Clinical Trials”, was presented at the American College of Rheumatology (ACR) 2021 Convergence.

According to the results, patient-reported pain continuously improved across multiple measures with guselkumab. Further evaluation needs to be done to assess patient-reported pain as an early and sensitive indicator of treatment effect in patients with active psoriatic arthritis.

The Motivation of the Studies

Pain relief was reported as a priority for treatment for patients with psoriatic arthritis. In 2 phase 3 trials, DISCOVER-1 & 2, a significant efficacy was shown when using guselkumab, compared to a placebo, in achieving ACR20 response at week 24 in patients with active psoriatic arthritis.

Investigators conducted post hoc analyses to continue to examine the effect of guselkumab on patient-reported pain across outcome measures, as well as maintenance of pain relief with up to 2 years of guselkumab treatment.

The Collaborative Results

Meaningful improvement in patient pain was displayed by substantial proportions of the 748 patients that were treated with guselkumab across both studies.

Greater than or equal to 20% Improvement was indicated by 32% at week 4 and 48% at week 8. Greater than or equal to 50% improvement was indicated by 28% at week 12 and 33% at week 16.

At week 24, 63% reported greater than or equal to 20% improvement and 39% reported greater than or equal to 50% improvement in pain.

DISCOVER-2

Patients treated with guselkumab reported twice the improvement in patient pain, spinal pain, joint pain and bodily pain intensity by week 24 compared with the control group. These improvements were maintained or further increased by week 52 and week 100.

Moderate pain and disease activity were indicated at the outset of the study by the mean baseline bodily pain, patient pain, spinal pain, joint pain, swollen joint counts, and tender joint counts.

The Method of the Studies

Included were 739 biologic-naive patients with active psoriatic arthritis. Patients were randomized to guselkumab 100mg every 4 weeks; guselkumab at week 0, week 4, then every 8 weeks; placebo with crossover to guselkumab 100mg every 4 weeks at week 24.

As part of ACR, disease activity in psoriatic arthritis, and minimal disease activity response criteria, pain was rated by patients using a 0-10 VAS for patient pain. Patients reviewed bodily pain intensity over their previous 4 weeks while completing the 36-item short-form health survey (SF-36) question 21 (0-5).

These promising results in pain improvement are the beginning to understanding the impact guselkumab has on pain in patients with psoriatic arthritis.

“Patient-reported pain as an early and sensitive indicator of treatment effect in patients with active psoriatic arthritis and other factors underlying pain merit further evaluation”, investigators wrote.