Guselkumab Improves Work Productivity, Daily Activity in Psoriatic Arthritis

Jeffrey R. Curtis, MD, MPH

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Guselkumab treatment displayed improvements in impairment of work productivity and nonwork daily activity, as well as in general health status, over two years among patients with active psoriatic arthritis (PsA), according to new research.¹

Most patients in the pivotal phase 3 DISCOVER-2 trial presented with significant impairments of work productivity, daily activity, and general health at baseline.² Treatment goals for PsA typically include optimization of functional status to improve both productivity and general health status.

“The long-term improvements in work productivity and overall health status observed among patients with PsA receiving guselkumab were also associated with potential indirect and employer-related economic benefits,” wrote the investigative team, led by Jeffrey R. Curtis, MD, MPH, department of medicine, immunology, and rheumatology, University of Alabama at Birmingham.¹

An estimated 20 to 50% of patients with PsA experience unemployment, with up to 4 in 10 reporting some degree of work disability.³ These patients may also experience substantial costs related to work absences, sick leaves, and short-term work disability in the United States.

The efficacy and safety of guselkumab, a high-affinity interleukin-23 p19-subunit inhibitor, were established in the pivotal phase 3 DISCOVER-1 and DISCOVER-2 studies.² In DISCOVER-2, every 4 or 8 weeks (Q4W/Q8W) guselkumab 100 mg was linked to significantly greater improvements across PsA domains, including reduced work productivity loss and improved general health status, over 1 year.

Curtis and colleagues indicated an improved understanding of the effect of guselkumab on PsA domain outcomes is crucial. In this analysis, the investigative team assessed the long-term effects of guselkumab on work productivity, daily activity impairment, and general health status through 2 years in the DISCOVER-2 trial.

In DISCOVER-2, adults with active PsA were randomly assigned to subcutaneous guselkumab 100 mg Q4W, guselkumab 100 mg Q8W, or placebo. The placebo cohort continued through week 24, with a crossover to receive guselkumab 100 mg Q4W.

Domains of work productivity, nonwork daily activity impairment, and employment status at weeks were measured using the Work Productivity and Activity Impairment Questionnaire for PsA (WPAI-PsA). General health status was assessed in the EuroQol 5-Dimension 5-Level (EQ-5D-5L) Index and EuroQol Visual Analog Scale (EQ-VAS). The least-squares mean changes from baseline in all domains were assessed at weeks 24, 52, and 100.

Overall, 739 patients were randomized in DISCOVER-2, and 652 (88.2%) completed treatment over 2 years. At baseline, the mean age was 46 years, 98% were White, and 47.5% were female. Investigators noted that 64.4% of patients were actively employed at baseline, but experienced notable impairment in most WPAI-PsA domains.

Upon analysis, those randomized to guselkumab exhibited significantly better improvement in work productivity and nonwork daily activity impairment, compared with placebo, through week 24 in both Q4W and Q8W treatment regimens. These improvements were maintained through week 52.

Among both guselkumab cohorts, the least-squares mean improvements were observed in work productivity impairment (Q4W, –23.8%; Q8W, –28.0%) and nonwork daily activity impairment (Q4W, –29.2%; Q8W, –28.0%).

Those randomized to guselkumab also had greater least-squares mean improvements compared with placebo in both the EQ-5D-5L Index and EQ-VAS scores at week 16 and improved further at week 24. The least-squares mean changes from baseline in both scores in the guselkumab groups were maintained through week 100 (EQ-5D-5L: 0.15 in both groups; EQ-VAS: Q4W, 25.0; Q8W, 24.6).

Among those employed at baseline, 16.1% (n = 22), 12.4% (n = 17), and 16.1% (n = 24), respectively, reported not being employed at week 100. On the other hand, 24.1% (n = 20), 25.3% (n = 22), and 20.0% (n = 13), respectively, of those not employed at baseline reported employment at week 100.

According to Curtis and colleagues, further cost analyses revealed guselkumab in PsA could result in substantial indirect and employer-related economic benefits. At week 100, the potential yearly cost savings in the USA were generally consistent across guselkumab cohorts, ranging from $16,529 in the Q4W cohort to $19,409 in the Q8W cohort.

“Rates of employment increased in patients treated with guselkumab who were not employed at baseline and observed improvements in work productivity were estimated to result in substantial yearly indirect work productivity-related cost savings,” they wrote.

References

1. _{Curtis, J.R., McInnes, I.B., Rahman, P. et al. Work Productivity and General Health Through 2 Years of Guselkumab Treatment in a Phase 3 Randomized Trial of Patients With Active Psoriatic Arthritis. Rheumatol Ther (2024). https://doi.org/10.1007/s40744-024-00642-9}
2. _{Mease PJ, Rahman P, Gottlieb AB, et al. Guselkumab in biologic-naïve patients with active psoriatic arthritis (DISCOVER-2): a double-blind, randomized, placebo-controlled phase 3 trial. Lancet. 2020;395:1126–36.}
3. _{Tillett W, de Vries C, McHugh NJ. Work disability in psoriatic arthritis: a systematic review. Rheumatology (Oxford). 2012;51:275–83.}