Frederic Lavie, MD, PhD: Guselkumab Demonstrates Rapid, Sustained Improvements in Severe PsA

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Treatment with guselkumab led to rapid, clinically meaningful improvements in disease activity among patients with severe psoriatic arthritis (PsA), which were maintained through 2 years.

In an interview with HCPLive, Frederic Lavie, MD, PhD, head of Global Medical Affairs Rheumatology at the Janssen Pharmaceutical Companies of Johnson & Johnson, discussed the findings of an analysis of the DISCOVER-1 and DISCOVER-2 trials, which enrolled bio-naïve patients with active PsA.

The study, presented at the 2024 European Congress of Rheumatology (EULAR), defined severe disease activity using 3 criteria: a Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) score above 27, a PsA Disease Activity Score (PASDAS) score above 5.4, and a Patient Global Assessment (PtGA) score above 8. These thresholds indicate very active disease from both clinical and patient perspectives. Investigators then analyzed the response levels and the timing of meaningful responses in these patients to assess whether guselkumab could offer early improvements.

Lavie explained the researchers at Janssen are continuously asking clinicians about the most challenging aspects of their practice and how they can assist. Providers often mention that while clinical trial criteria enroll patients with active disease, real-world cases can be even more severe. There's uncertainty about whether current drugs are sufficient for these patients, including ones like guselkumab.

However, results showed guselkumab had significant positive effects among this patient population. For patients with severe cDAPSA at baseline, as early as week 2, there was a noticeable improvement compared with placebo. By week 24, patients treated with guselkumab showed a 72% improvement, with more than 81% maintaining this response at week 100.

For patients with severe PASDAS at baseline, improvements in joint disease activity were evident by week 8, which continued through week 24, with a 54% improvement and 79% maintenance at week 100. Similarly, for patients with severe PtGA scores, guselkumab led to significant improvements by week eight, sustained through week 24, with a 63% improvement and 81% maintenance at week 100.

Lavie noted these results were particularly positive, reinforcing the idea that targeting interleukin (IL)-23 is an effective strategy for managing severe PsA, and it could be crucial for both symptom control and long-term disease management.

Despite the high response levels at week 100, Lavie and his team aim to further enhance remission rates. This impulse continues to drive the ongoing research into new mechanisms of action and better disease management strategies for psoriatic arthritis.

Disclosures: Lavie is the head of Global Medical Affairs Rheumatology at Janssen.