Summary: Guselkumab, administered every eight weeks, has shown sustained improvements in disease activity and alleviation of both skin and joint symptoms over two years for patients with psoriatic arthritis (PsA) who have not previously received biologic treatment.
Study Overview: A post hoc analysis of the phase 3 DISCOVER-2 trial evaluated the effectiveness of guselkumab in managing disease control during consecutive dosing visits and the durability of clinically significant improvements. The study involved 248 participants, with a mean age of 44.9 years, and included 48% women. All subjects had active PsA and were naive to biologic therapies. They were randomly assigned to receive 100 mg of guselkumab at weeks 0 and 4, followed by doses every eight weeks. Notably, 90% of patients continued treatment through week 100.
Key Findings: Among those receiving guselkumab every eight weeks, an impressive 93% to 99% maintained minimal clinically important improvements in joint symptoms, as measured by the Disease Activity Index in PsA (DAPSA), at successive dosing visits up to week 52. Furthermore, 68% to 89% of patients who exhibited these improvements in joint or skin symptoms and overall disease activity by week 24 sustained their benefits by week 100. The estimated mean durations for maintaining clinically important improvements were 76.7 weeks for overall disease activity (evaluated via the PsA Disease Activity Score), 58.6 weeks for joint activity (measured by the DAPSA score), and 75.7 weeks for skin disease (assessed through the Investigator’s Global Assessment score). Notably, participants did not reach the median time for loss of improvement.
Clinical Implications: “Guselkumab every eight weeks demonstrated significant and sustained joint efficacy over one year and continued to provide benefits across various PsA domains for up to two years,” stated the authors. They emphasized that these findings could guide physicians and patients in developing and monitoring treatment strategies.
Research Details: The study was spearheaded by Philip J. Mease, MD, from Providence Swedish Medical Center and the University of Washington School of Medicine in Seattle. Results were published online on October 4, 2024, in ACR Open Rheumatology.
Study Limitations: The trial’s population consisted exclusively of biologic-naive patients, potentially limiting the applicability of the results to a broader patient demographic. Additionally, the analysis focused on efficacy evaluations conducted at specific eight-week dosing intervals, which restricted insights into treatment effectiveness during the intervals. The study also did not encompass all outcomes due to extended data collection timelines beyond week 52.
Funding and Disclosures: The research received support from Janssen Research & Development. Several authors disclosed holding stock options with the funding source, while others reported various connections to pharmaceutical companies.
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