The following article is a part of conference coverage from the American College of Rheumatology (ACR) Convergence 2021, being held virtually from November 3 to 10, 2021. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the ACR Convergence 2021.
Selective interleukin (IL)-23 inhibitor guselkumab is effective in the resolution of enthesitis and dactylitis in patients with psoriatic arthritis (PsA), according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 5 to 10, 2021.
Previously, the DISCOVER-1 and -2 trials supported the efficacy of guselkumab in patients with PsA, reporting significant improvements in dactylitis and enthesitis.
The objective of the current study was to investigate the long-term efficacy of guselkumab through 2 years of the DISCOVER-2 trial.
The study included 739 biologic-naive patients with active PsA, including 331 patients with dactylitis and 506 patients with enthesitis. More participants had enthesitis than dactylitis (68% vs 45%, respectively) at baseline. A total of 78% of patients with dactylitis had enthesitis compared with 61% of those without dactylitis. Dactylitis was present in 51% of patients with enthesitis compared with 32% without enthesitis. Severe enthesitis was more common among patients with vs without dactylitis (52% vs 44%, respectively).
Overall, 245 patients were randomly assigned to receive guselkumab 100 mg every 4 weeks (n=121 with dactylitis; n=170 with enthesitis); 248 patients were randomly assigned to receive guselkumab 100 mg every 8 weeks (n=111 with dactylitis; n=158 with enthesitis); and 246 were randomly assigned to receive placebo (n=99 with dactylitis; n=178 with enthesitis). After 24 weeks, patients in the placebo group crossed over to receive guselkumab every 4 weeks.
Dactylitis and enthesitis were evaluated by independent assessors, and the Leeds Enthesitis Index score was used to determine changes and resolution in the manifestations among those with dactylitis or enthesitis at baseline.
Among patients who received treatment with guselkumab every 4 weeks, the rates of resolution of dactylitis was 57% after 24 weeks, 74% after 52 weeks, and 72% after 100 weeks. Among those who received treatment with guselkumab every 8 weeks, the rates of resolution of dactylitis were 64% after 24 weeks, 78% after 52 weeks, and 83% after 100 weeks.
Among patients who received treatment with guselkumab every 4 weeks, resolution of enthesitis was reported among 44%, 57%, and 62% of patients after 24 weeks, 52 weeks, and 100 weeks, respectively. Similarly, among those who received treatment with guselkumab every 8 weeks, resolution of enthesitis was observed among 54%, 61%, and 70% of patients after 24 weeks, 52 weeks, and 100 weeks, respectively.
There were significant correlations between resolution of enthesitis and dactylitis among patients with both dactylitis and enthesitis who received treatment with guselkumab. At week 24, 70.9% of patients who achieved enthesitis resolution had resolution of dactylitis (P =.004), with rates increasing to 88.8% and 88.1% of patients after 52 weeks and 100 weeks, respectively (P <.001 and P =.039, respectively). Similarly, enthesitis resolution was reported in 54.9% of patients who achieved resolution of dactylitis (P =.004), with rates increasing to 66.4% and 72.7% of patients after 52 weeks and 100 weeks, respectively (P <.001 and P =.039, respectively).
“Patients with PsA often present with concurrent enthesitis and dactylitis, both of which can be recalcitrant to treatment. [Guselkumab] resolved enthesitis and dactylitis in substantial proportions of [patients] through [week] 100. [Guselkumab]-treated [patients] who achieved enthesitis resolution were more likely to achieve dactylitis resolution and vice versa,” the researchers concluded.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
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Rahman P, McInnes I, Deodhar A, et al. Guselkumab (TREMFYA®) maintains resolution of dactylitis and enthesitis in patients with active psoriatic arthritis: results through 2 years from a phase 3 study. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 1329.