Psoriasis: guselkumab superior to secukinumab in head-to-head trial

  • Lancet

  • International Clinical Digest
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Takeaway

  • Guselkumab, an IL-23 inhibitor, is associated with superior skin clearance vs secukinumab, an IL-17A inhibitor, in patients with moderate to severe psoriasis, according to results from the phase 3 ECLIPSE trial.

Why this matters

  • Several treatment options for psoriasis have recently become available, necessitating head-to-head trials.

Key results

  • Guselkumab was associated with a superior rate of ≥90% improvement in the Psoriasis Area and Severity Index (PASI 90) compared with secukinumab at week 48 (primary endpoint).
    • 84% vs 70% (P<.0001 in intent-to-treat analysis.>
    • 88% vs 76% (P<.0001 in per protocol analysis>
  • Guselkumab was noninferior to secukinumab for PASI 75 response rates at weeks 12 and 48, but superiority was not demonstrated (P=.0616).
  • Safety profiles were similar to those observed in the primary studies.
    • The most common adverse events were nasopharyngitis (22% in the guselkumab group, 24% in the secukinumab group) and upper respiratory tract infection (16% in the guselkumab group, 18% in the secukinumab group).

Study design

  • 1048 patients with moderate to severe psoriasis (534 who received guselkumab and 514 who received secukinumab) were analysed for outcomes.
  • Funding: Janssen Research & Development.

Limitations

  • No assessments of drug concentration and antibody data for secukinumab.

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