Treatment with guselkumab compared with interleukin (IL)-17A and tumor necrosis factor (TNF) inhibitors showed favorable efficacy, with better Psoriasis Area Severity Index (PASI) response, in patients with psoriatic arthritis (PsA), t, , according to results of a systematic literature review and network meta-analysis published in Rheumatology.

Guselkumab, a monoclonal antibody that selectively inhibits the p19 subunit of IL-23, was found to be effective and safe for patients with PsA in the placebo-controlled DISCOVER-1 and -2 phase 3 trials. The current analysis was aimed at assessing the skin and joint efficacy and safety of guselkumab compared with other targeted therapies for PsA.

In a literature search, researchers identified 26 (62 citations) phase 3, randomized-controlled trials including 13 targeted therapies for PsA. They conducted a network meta-analysis to compare guselkumab with other targeted therapies, based on the American College of Rheumatology (ACR) 20/50/70 response, mean change from baseline in van der Heijde-Sharp (vdH-S) score, PASI 75/90/100 response, and adverse and serious adverse events.


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Guselkumab 100 mg every 8 weeks or every 4 weeks was associated with comparable efficacy to IL-17A and TNF inhibitors for both ACR responses and the vdH-S score (except intravenous TNF therapies).

Except 2 studies, all reported PASI 75 response; most studies reported PASI 90 response and a few reported PASI 100 response. Compared with other treatments, guselkumab every 8 weeks had better PASI 75 and PASI 90 responses, indicating a greater impact on skin manifestations. Comparisons vs guselkumab every 4 weeks were similar with those vs guselkumab every 8 weeks for all PASI responses.

Both guselkumab every 8 weeks and every 4 weeks ranked highly in the network for adverse events and serious adverse events, but rarity of events led to significant uncertainty in pairwise comparisons.  

The study had several limitations, including assessment at varied time points, heterogeneity due to inclusion of patients regardless of prior biologic exposure, and low baseline event rates.

“Overall, guselkumab offers favorable outcomes for patients with PsA by improving both rheumatological and dermatological outcomes coupled with a favorable safety profile,” the researchers concluded.

Disclosure: This research was supported by Janssen Research and Development. Please see the original reference for a full list of disclosures.

Reference

Mease PJ, McInnes IB, Tam L-S, et al. Comparative effectiveness of guselkumab in psoriatic arthritis: results from systematic literature review and network meta-analysis. Rheumatology (Oxford).  Published online March 24, 2021. doi:10.1093/rheumatology/keab119