Efficacy and safety of guselkumab in psoriasis patients who failed ustekinumab and/or anti‐ interleukin ‐17 treatment: A real‐life 52‐week retrospective study

Abstract

Recent major research advancements have significantly expanded our understanding of psoriasis pathophysiology, resulting in the development of highly effective, targeted therapies. Guselkumab is the first interleukin (IL)‐23 inhibitor approved for the treatment of moderate‐to‐severe‐psoriasis, providing a new therapeutical option for psoriasis. The aim of our study was to evaluate the efficacy of guselkumab in psoriatic patients who previously failed anti‐IL‐12/23 and/or anti‐IL‐17 treatment. A 52‐week single‐center retrospective study was performed enrolling moderate‐to‐severe patients attending our Psoriasis Care Center from October 2018 to May 2020. Study population included 13 patients; 46.1% have been previously treated with ustekinumab, while 69.2% have previously failed an anti‐IL‐17 treatment (38.5% secukinumab, 30.8% ixekizumab, and 38.5% both). At baseline, mean Psoriasis Area and Severity Index was 13.2 ± 6.8, reducing up to 0.5 ± 0.7 at week 52 (P < .001). Body surface area reduced from 22.3 ± 10.5 (baseline) to 0.8 ± 1.1 at week 52 (P < .001). No statistically significant differences have been found between patients previously treated with anti‐IL‐12/23 compared to anti‐IL‐17 or both. Only one patient discontinued guselkumab at week 36 due to secondary inefficacy. This is a single institution study with a relatively small sample size. Our real‐life data confirm trial results, showing guselkumab as a safe and effective option in patients with moderate‐to‐severe psoriasis even in those who previously failed ustekinumab and/or anti‐IL‐17 treatment.

Impact of previous biologic use and body weight on the effectiveness of guselkumab in moderate-to-severe plaque psoriasis: a real-world practice

“…Moreover, the population was limited to a small-scale and the Western population. 15 – 18 The patients previously treated with biologics in this study were less likely to achieve PASI 75 than biologic-naïve patients. Furthermore, lower PASI 75 response rate to guselkumab was noted as the number of previous biologics used increased.…”

“…These studies are mostly short-term, have small population sizes, and comprise non-Asian populations. 8 , 15 – 19 , 21 PASI 75 and PASI 90 responses to guselkumab in two short-term (16 weeks) multicentre real-life studies showed that 82.1% and 72.2% of patients achieved PASI 75, whereas 55.4% and 50.6% achieved PASI 90 at week 16. 8 , 15 Our patients responded to guselkumab even worse compared with those in other real-life studies.…”

“…15,16,19,21 Predictors of a PASI response to guselkumab available from real-life studies are relatively lacking and inconsistent. [15][16][17][18] The efficacy of biologics was lower in patients with higher BW, which might be due to the increased volume of drug distribution and low level of drug concentration. 23 The efficacy was maintained in weight-based dosage of biologics such as infliximab, even with increasing weight.…”

“… 15 , 16 , 19 , 21 Predictors of a PASI response to guselkumab available from real-life studies are relatively lacking and inconsistent. 15 – 18 …”

“…Real-life studies on the use of guselkumab in the treatment of psoriasis are relatively few compared with those of other biologics. These studies are mostly shortterm, have small population sizes, and comprise non-Asian populations 8,[15][16][17][18][19]21. PASI 75 and PASI 90 responses to guselkumab in two shortterm (16 weeks) multicentre real-life studies showed that 82.1% and 72.2% of patients achieved PASI 75, whereas 55.4% and 50.6% achieved PASI 90 at week 16.…”