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In the updated analysis, the interleukin-23 p19-subunit inhibitor also showed better skin efficacy.
According to an updated network meta-analysis (NMA), guselkumab (Tremfya, Janssen Biotech) demonstrated better skin efficacy than most other targeted psoriatic arthritis (PsA) therapies, including the Janus kinase (JAK) inhibitor upadacitinib. The results, which were published in Rheumatology, also showed guselkumab may offer arthritis efficacy that is comparable to interleukin (IL)-17A, JAK and subcutaneous tumor necrosis factor (TNF) inhibitors, and a similar safety profile to most other agents.1
“This is the first NMA to include the newest disease-modifying antirheumatic drugs (DMARDs), risankizumab and upadacitinib,” explained Philip Mease, MD, clinical professor at the University of Washington School of Medicine and director of rheumatology research at the Swedish Medical Center in Seattle, and colleagues. “As the number of treatments expands, estimating relative effectiveness and safety through NMA may help guide evidence-based decision making for clinicians and payers.”
In a prior NMA, guselkumab, an IL-23 p19-subunit inhibitor, showed favorable Psoriasis Area and Severity Index (PASI) responses and comparable arthritis efficacy, as measured by American College of Rheumatology (ACR) and modified van der Heijde–Sharp (vdH-S) scores, compared with IL-17A and most TNF inhibitors.2
The NMA update included guselkumab data from the phase 3 COSMOS trial in patients with an inadequate response to TNF inhibitors. The update also compared guselkumab to upadacitinib and the IL-23 inhibitor risankizumab. A systematic literature review identified randomized controlled trials up to February 2021 and hand-search identified newer agents up to July of that year. ACR response, PASI response, modified vdH-S score and serious adverse events (SAEs) were compared between treatments.
For ACR 20, guselkumab 100 mg every 8 weeks and every 4 weeks were comparable to most other agents, including risankizumab, upadacitinib, subcutaneous TNF inhibitors, and most IL-17A inhibitors. For PASI 90, both doses of guselkumab were better than multiple agents, including subcutaneous TNF inhibitors and JAK inhibitors. For modified vdH-S, guselkumab 100 mg every 8 weeks was similar to risankizumab, while guselkumab 100 mg every 4 weeks was better than risankizumab.
The SAEs were comparable amongst most agents. Guselkumab 100 mg every 8 weeks and every 4 weeks ranked ninth and sixth, respectively, among 23 interventions. Both guselkumab doses were better than certolizumab 400 mg and infliximab 5 mg.
“Guselkumab has a favorable safety profile similar to most other agents,” the authors wrote.
1. Mease PJ, McInnes IB, Tam LS, et al. Comparative effectiveness of guselkumab in psoriatic arthritis: updates to a systematic literature review and network meta-analysis. Rheumatology (Oxford). 2023;62(4):1417-1425. doi:10.1093/rheumatology/keac500
2. Mease PJ, McInnes IB, Tam LS, et al. Comparative effectiveness of guselkumab in psoriatic arthritis: results from systematic literature review and network meta-analysis. Rheumatology (Oxford). 2021;60(5):2109-2121. doi:10.1093/rheumatology/keab119