Guselkumab Shows Greater Treatment Persistence than IL-17s in Both Bio-naïve and Bio-experienced Psoriasis Patients

March 17, 2023

Guselkumab also showed improvements in scalp psoriasis and quality-of-life measures at week 48.

Tremyfa (guselkumab) may beat out other biologics when it comes to patient persistence, and a post-hoc analysis of guselkumab showed improvements in scalp psoriasis and quality-of-life measures at week 48.

Research found that bio-experienced and bio-naïve psoriasis patients were more likely to stay on guselkumab than secukinumab or ixekizumab based on pairwise analyses in a real-world setting. A posthoc analysis of Phase 3 data demonstrated durable clinical efficacy, itch relief and quality-of-life improvements in patients living with scalp psoriasis.

Both studies were presented at the annual meeting of the American Academy of Dermatology in New Orleans.

Given by injection under the skin at week 0 and week 4, and then every 8 weeks afterward, guselkumab is U.S. Food and Drug Administration (FDA) approved for moderate-to-severe plaque psoriasis and active psoriatic arthritis in adults.

The first report included 1,314 and 3,294 patient pairs for analysis of guselkumab and secukinumab cohorts and 1,564 and 2,667 pairs for pairwise analysis of guselkumab and ixekizumab cohorts, respectively.  These patients were bio-experienced. 

The median time to index treatment discontinuation in months was 26.2 for guselkumab versus 10.7 for secukinumab, and 25.9 for guselkumab versus 13.0 for ixekizumab. At 12 months, the guselkumab cohort was 2.00 times more persistent versus secukinumab and 76 percent more persistent versus ixekizumab.  At 18 months, the guselkumab cohort was 2.04 times more persistent versus secukinumab and 1.67 times more persistent versus ixekizumab, the study showed.

In addition, an analysis of real-world data showed guselkumab with longer median time to index treatment discontinuation compared to secukinumab and ixekizumab among bio-naïve patients.

The guselkumab cohort showed 2.20 times (at 12 months) and 2.28 times (at 18 months) longer persistence versus the secukinumab cohort, and 1.84 times (at 12 months) and 1.86 times (at 18 months) longer persistence versus the ixekizumab cohort, the study showed. 

“Current psoriasis treatments are revolutionary and have revolutionized patients’ lives,” says study author Steven R. Feldman, MD, Professor of Dermatology, Pathology, and Public Health Sciences at Wake Forest School of Medicine in Winston-Salem, North Carolina. “They are very safe and very effective, but eventually patients may develop antibodies, or experience a safety event, and they will stop taking the medication,” he says.

“The key takeaway is that as expected and based on clinical experience, the patient persistence on guselkumab is greater than on two other biologic drugs,” he tells DermWire.

Exactly why patients are more likely to stay on guselkumab is not fully understood. “Interleukin (IL)-23 is genetically linked to having psoriasis, and in some ways, we may be getting to the bottom-line underlying cause when blocking il-23,” he said. “It could be more immunogenic or there may be more safety issues with other agents, or it might be relayed to how well the drug holds its efficiency.”

This new data may encourage more dermatologists to consider guselkumab. “Knowing that guselkumab has a really good long-term persistence in real-world data would be a selling point.”

New Scalp Psoriasis Data

The Phase III VOYAGE 2 trial compared guselkumab with placebo and with adalimumab in patients with moderate-to-severe plaque psoriasis. . At W28, Psoriasis Area and Severity Index (PASI) 90 responders were re-randomized to continue (n=159) or discontinue (n=164) guselkumab; non-responders continued guselkumab (n=84). 

The post hoc analysis explored scalp responses during guselkumab treatment and withdrawal in patients with scalp involvement (as indicated at screening) who were randomized to guselkumab 100 mg at W0 and W4, then every 8 weeks. 

Among guselkumab responders remaining on treatment, the mean scalp-specific Investigator Global Assessment (ss-IGA) score rapidly declined from 2.9 at W0 to 0.2 at W24, and 0.3 at W48; mean PASI head scores were 2.0, 0.1 and 0.1, respectively, and were consistent with total PASI score improvements (21.9, 0.6 and 1.0, respectively)

“Scalp psoriasis doesn’t cover a large body surface area, but it can be hard to treat and is extremely frustrating for patients and doctors. It is hard to get people to rub cream on the scalp,” Dr. Feldman says. “We saw a 90-95 percent improvement in scalp and head scores, which is a really remarkable level of improvement."

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