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 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

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