Guselkumab Yields Durable Improvements in Psoriatic Arthritis

Philip J. Mease, MD

Credit: The Rheumatology Education Group

Guselkumab durably improved disease measures in patients with psoriatic arthritis (PsA), including disease activity and patient and physician-driven assessments.¹

“Considering the chronic and heterogeneous nature of PsA and multiple factors influencing patient outcomes², a consistent treatment effect at consecutive dosing visits and persistence of response over time may allow for continuous improvement and greater probability of achieving durable disease control,” lead investigator Philip J. Mease, MD, Clinical Professor, University of Washington School of Medicine and Director, Rheumatology Research, Swedish Medical Center, and colleagues wrote.¹

Mease and colleagues conduced posthoc analyses that included biologic-naïve patients randomized to 100 mg of guselkumab at week 0, week 4, and then every 8 weeks (Q8W). They analyzed improvements in joints using Disease Activity Index for PsA (DAPSA), skin using Investigator's Global Assessment (IGA), and overall disease activity using patient global assessment of arthritis and psoriasis (PtGA Arthritis+Psoriasis) and PsA Disease Activity Score PASDAS. They evaluated that proportion of patients with maintenance of DAPSA and cDAPSA minimal clinically important improvement (MCII) at weeks 4 and 12, weeks 12 and 20, continuing through week 52, and patient-level durability of response through week 100 were determined via Kaplan-Meier analyses.

The investigators found that of the 248 patients randomized to guselkumab Q8W, 93% to 99% maintained MCII in joint disease at consecutive Q8W dosing visits through week 52. Of the participants achieving MCII by week 24, 68% (IGA 0/1) to 89% (PASDAS MCII) were estimated to maintain clinical improvement 100 weeks post achievement.¹

Most patients (range, 95%-99%) maintained cDAPSA MCII at each subsequent time period assessed. Of the 195 participants that had IGA scores of at least 2 at baseline, 181 (93%) patients achieved IGA scores of 0/1 (clear or minimal skin psoriasis) by week 24 of guselkumab Q8W treatment. By week 24 of guselkumab Q8W, 62% (147 of 239) of patients with baseline IGA scores of at least 1 achieved IGA 0.¹

By week 24 of guselkumab Q8W, a majority (73%, n = 182 of 248) of participants also achieved PtGA Arthritis+Psoriasis. When assessed via a composite measure of overall disease activity, 90% (224 of 248) of patients achieved PASDAS MCII by week 24 with guselkumab Q8W.¹

Participants did not reach a median time to loss of improvement and had an estimated 58.6 mean weeks of MCII maintenance on DPASA, 52.4 mean weeks of cDAPSA, 75.5 for IGA, 83.6 for PtGA Arthritis+Psoriasis, and 76.7 for PASDAS.¹

“Evaluation of individual patient improvements showed that guselkumab Q8W provided highly durable joint efficacy at consecutive Q8W dosing visits through 1 year and conferred persistent benefits across PsA domains through 2 years, consistent with previously reported continuous improvement in group-level clinical response rates over time. These study findings may further inform physicians and patients when initiating and monitoring treatment plans,” Mease and colleagues concluded.¹

REFERENCES

1. Mease PJ, Baraliakos X, Chandran V, et al. Persistent Patient-Level Effect of Guselkumab at Consecutive 8-Week Dosing Visits and Over Time in Patients With Active Psoriatic Arthritis: Post Hoc Analysis of a 2-Year, Phase 3, Randomized, Controlled Study. ACR Open Rheumatol. Published online October 4, 2024. doi:10.1002/acr2.11732

2. Coates LC, Soriano ER, Corp N, et al; GRAPPA Treatment Recommendations domain subcommittees. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol 2022; 18(8): 465–479.