guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs

Last edited 08/2022 and last reviewed 09/2022

Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs

Guselkumab

• is a human monoclonal antibody that selectively inhibits interleukin (IL)-23 by binding the cytokine's p19 subunit
• is the first IL-23 inhibitor approved to treat adults with moderate-to-severe plaque psoriasis (PsO) and active PsA (psoriatic arthritis)
• demonstrated superior efficacy versus placebo at week 24 across all PsA disease domains evaluated, regardless of baseline patient demographics, disease characteristics or medication use (1)

NICE state that:

• Guselkumab, alone or with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults whose disease has not responded well enough to disease-modifying antirheumatic drugs (DMARDs) or who cannot tolerate them. It is recommended only if they have had 2 conventional DMARDs and:

  • have had at least 1 biological DMARD, or

  • tumour necrosis factor (TNF)-alpha inhibitors are contraindicated but would otherwise be considered (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis)

Guselkumab is recommended only if the company provides it according to the commercial arrangement. Active psoriatic arthritis is defined as peripheral arthritis with 3 or more tender joints and 3 or more swollen joints

Assess the response to guselkumab from 16 weeks. Stop guselkumab at 24 weeks if the psoriatic arthritis has not responded adequately using the Psoriatic Arthritis Response Criteria (PsARC; an adequate response is an improvement in at least 2 of the 4 criteria, 1 of which must be joint tenderness or swelling score, with no worsening in any of the 4 criteria). If the PsARC response is not adequate but there is a Psoriasis Area and Severity Index (PASI) 75 response, a dermatologist should decide whether continuing treatment is appropriate based on skin response

The NICE committee commented that:

• "...Clinical evidence shows that guselkumab is effective compared with placebo, but it has not been compared directly with other biological DMARDs for treating psoriatic arthritis. An indirect comparison suggests that guselkumab is as effective as the biological DMARDs secukinumab and ixekizumab, particularly for skin symptoms..."

For complete details then consult NICE (August 2022). Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs

Reference:

• Ritchlin CT, Mease PJ, Boehncke WH, Tesser J, Schiopu E, Chakravarty SD, Kollmeier AP, Xu XL, Shawi M, Jiang Y, Sheng S, Wang Y, Xu S, Merola JF, McInnes IB, Deodhar A. Sustained and improved guselkumab response in patients with active psoriatic arthritis regardless of baseline demographic and disease characteristics: pooled results through week 52 of two phase III, randomised, placebo-controlled studies. RMD Open. 2022 Mar;8(1):e002195.
• NICE (August 2022). Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs