Psoriasis: cytokine suppression tied to continued response after stopping guselkumab

  • Gordon KB & al.
  • J Invest Dermatol
  • 14 Jun 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Suppression of IL-23-regulated IL-17 and IL-22 is associated with efficacy of guselkumab (Tremfya) after withdrawal in patients with psoriasis, according to results for the VOYAGE 2 trial.

Why this matters

  • Patients may need to interrupt therapy for a variety of reasons, necessitating better understanding of efficacy and safety of retreatment after interruption.

Study design

  • Patients with psoriasis treated with guselkumab who achieved PASI 90 were rerandomized for guselkumab withdrawal (N=182) or guselkumab maintenance (N=193).
  • Patients who withdrew from guselkumab and experienced loss of ≥50% of week 28 PASI improvement or by week 72 reinitiated guselkumab.
  • Funding: Janssen Research & Development, LLC.

Key results

  • Patients who received guselkumab maintenance had higher efficacy at week 72 compared with patients who received guselkumab withdrawal (86.0% vs 11.5% achieved ≥90% improvement in Psoriasis Area and Severity Index [PASI 90]; P<.001>
  • 80.4% of patients from the guselkumab withdrawal group achieved PASI 90 after 20 weeks of guselkumab retreatment.
  • Maintenance of response after withdrawal was associated with suppression of IL-17A, IL-17F, and IL-22.
  • Adverse events, discontinuations because of adverse events, and serious adverse events were generally comparable between the guselkumab withdrawal and guselkumab maintenance groups.

    Limitations

    • Limited evaluation of serum markers.