Patients With Active Psoriatic Arthritis Achieve Continuous Disease Improvement With Guselkumab

Patients with active psoriatic arthritis (PsA) were able to achieve continuous improvement with guselkumab through different trajectories of individual minimal disease activity (MDA) criteria, according to a recent study.

psoriatic arthritis hand illustration | vectorwin - stock.adobe.com

These findings highlight how the identification of modifiable factors offers a multidisciplinary approach to managing PsA using both medical and lifestyle interventions.

The phase 3, randomized, placebo-controlled study is published in BMC Rheumatology.

“MDA is designed to define a state that is a useful target to both patients and clinicians,” wrote the researchers of the study. “Although important for predicting patient response to treatment, the ability to predict overall MDA achievement does not provide insight as to the type of intervention that may be needed to optimize patient outcomes. However, predicting longitudinal trajectories of the individual MDA components could form the basis for precision medicine in PsA.”

The study included information from patients (N = 739) with active PsA through 2 years from the DISCOVER-2 study (NCT03158285). This phase 3 study was comprised of a placebo-controlled period (week 0-24) and an active treatment period (week 24-100), with patients randomized 1:1:1 to receive guselkumab 100 mg every 4 weeks; at week 0, week 4, and then every 8 weeks; or placebo.

In the post hoc analysis, 493 patients were included and pooled from the DISCOVER-2 study. Achievement of each MDA criterion and overall MDA response were evaluated through week 100, with MDA defined as the fulfillment of 5 or more of the following:

• Tender joint count (TJC) ≤ 1
• Swollen joint count (SJC) ≤ 1
• Psoriasis Area and Severity Index (PASI) score ≤ 1 or body surface area (BSA) ≤ 3%
• Patient-reported pain visual analog scale (VAS) ≤ 15 mm
• Patient global assessment of disease activity VAS ≤ 20 mm
• Health Assessment Questionnaire-Disability Index (HAQ-DI) score ≤ 0.5
• Tender entheseal points ≤ 1

The analysis revealed that patients experienced continuous improvement across all MDA domains over time, with about 70% of patients achieving near remission in SJC, PASI, and enthesitis through week 100. Additionally, the researchers observed that median times to achieve individual criteria differed significantly (P < .0001), with SJC ≤ 1 achieved at 20 weeks, PASI ≤ 1 at 16 weeks, and tender entheseal points ≤ 1 at 16 weeks being faster than patient-reported criteria and TJC. Furthermore, higher baseline domain scores, older age, worse fatigue, and increased body mass index (BMI) were significant predictors of longer time to achieve minimal levels of disease activity using patient-reported criteria.

However, the researchers acknowledged some limitations to their analysis, including the potential “cherry picking” of data and lack of statistical power. The researchers also noted that the median time to achieve minimal PASI may have been overestimated since it was not assessed prior to week 16. Furthermore, these results may not be generalizable to real-world populations of patients with PsA and to patients treated with different medications or nonbiologic therapies.

Despite these limitations, the researchers believe treatment with guselkumab was associated with continuously increasing rates of achieving overall MDA and individual MDA criteria through 2 years in patients with active PsA.

“Times to near remission in physician-assessed MDA domains (SJC, PASI, enthesitis) supported rapid achievement of treatment targets with guselkumab,” wrote the researchers. “Regarding the patient-reported domains, several determinants were identified including modifiable factors such as BMI, pain, fatigue, and mental health which, with early multidisciplinary management, could assist in optimizing achievement of MDA and possibly sustained MDA.”

Reference

Coates LC, Rahman P, Mease, PJ, et al. Continuous improvement through differential trajectories of individual minimal disease activity criteria with guselkumab in active psoriatic arthritis: post hoc analysis of a phase 3, randomized, double-blind, placebo-controlled study. BMC Rheumatol. Published online February 4, 2024. doi:10.1186/s41927-024-00375-w