Among patients with psoriatic arthritis (PsA), treatment with guselkumab provides high rates of enthesitis resolution, with maintenance of resolution through 12 months, according to study results published in Rheumatology. Furthermore, patients with resolved enthesitis are more likely to achieve minimal disease activity.
The objective of the current study was to determine the effect of guselkumab on enthesitis in patients with PsA and explore the association between resolution of enthesitis and patient outcomes.
Researchers evaluated the efficacy of guselkumab in resolving and preventing enthesitis using data from patients with active PsA enrolled in the Phase-3 DISCOVER-1 and DISCOVER-2 studies (ClinicalTrials.gov Identifiers: NCT03162796 and NCT03158285, respectively). They used the Leeds Enthesitis Index (LEI; score range, 0-6) to evaluate enthesitis through 24 weeks and at 52 weeks of guselkumab treatment.
A total of 1118 patients with PsA were included in the current analysis, with 728 (65%) who had enthesitis at baseline. Patients with vs without enthesitis at baseline had numerically more swollen (12.3 vs 9.8, respectively) and tender (23.8 vs 14.6, respectively) joints.
At week 24, enthesitis resolution rates were 45% (n=109/243) among patients who received treatment with guselkumab every 4 weeks and 50% (n=114/230) among those who received guselkumab every 8 weeks, compared with 29% (n=75/255) among those who received placebo (P =.0301 for both). Median time to resolution of enthesitis was shorter among patients who received guselkumab vs those who received placebo (16 vs 24 weeks, respectively).
At week 52, the researchers reported enthesitis resolution in 70% to 75% of patients who received guselkumab with mild enthesitis (LEI=1) at baseline, in 69% to 73% of those with moderate enthesitis (LEI=2), and in 42% to 44% of those with severe enthesitis (LEI=3-6). In addition, resolution was reported in 80% of participants who switched to guselkumab every 4 weeks at week 24.
At week 52, patients with resolved enthesitis were more likely to achieve minimal disease activity compared with those with unresolved enthesitis (42% vs 17%, respectively).
The study had several limitations, including the lack of an active comparator, as well as the use of post-hoc analyses of pooled data and not from a prospective randomized trial.
“Guselkumab resulted in higher proportions of patients [with PsA] with resolved enthesitis by [week] 24, with maintenance of resolution rates through 1 year. As enthesitis confers greater disease burden, sustained resolution could portend better patient outcomes,” the researchers concluded.
Disclosure: This study was supported by Janssen Research & Development, LLC. Please see the original reference for a full list of authors’ disclosures.
McGonagle D, McInnes IB, Deodhar A, et al. Resolution of enthesitis by guselkumab and relationships to disease burden: 1-year results of two phase-3 psoriatic arthritis studies. Rheumatology (Oxford). Published online April 6, 2021. doi:10.1093/rheumatology/keab285