Which Biologic Is More Effective for Psoriasis in Difficult to Treat Areas?
Guselkumab (Tremfya) was associated with significant improvements in psoriasis on the scalp, palms, and soles of the feet compared with adalimumab (Humira), according to the findings of a recent study.
In their post-hoc analysis, the researchers examined data from VOYAGE 1 and VOYAGE 2, which were double-blind, placebo- and adalimumab-controlled studies of guselkumab conducted at 101 and 115 global sites, respectively. Participants in both trials had moderate to severe plaque psoriasis (N=1829) and were randomized to 100 mg of guselkumab, which was administered at week 0 and 4 followed by every 8 weeks, or placebo followed by 100 mg of guselkumab starting at week 16, or adalimumab at a dose of 80 mg at baseline followed by a dose of 40 mg at week 1, then administered every 2 weeks.
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The main outcomes included the number of participants who achieved scores of 0 or 1 (clear or almost clear) or 0 (clear) on the scalp specific Investigator’s Global Assessment (ss-IGA), Physician’s Global Assessment of the hands and feet (hf-PGA), and finger nail PGA (f-PGA), as well as the percentage of participants who experienced improvements in the target Nail Psoriasis Severity Index score. All assessments were conducted through week 24.
At week 16, a greater proportion of participants who received guselkumab achieved a ss-IGA score of 0 or 1 compared with placebo (560 [81.8%] vs 43 [12.4%]). A greater proportion of participants who received guselkumab achieved a ss-IGA score of 0 or 1 compared with adalimumab at week 24 (582 [85%] vs 329 [68.5%]). Additionally, 479 participants (69.9%) who received guselkumab achieved a ss-IGA score of 0 compared with 270 participants who received adalimumab.
Guselkumab was found to be superior for achieving hf-PGA score of 0 or 1 compared with placebo at week 16 (154 [75.5%] vs 15 [14.2%], respectively) and adalimumab at week 24 (164 [80.4% vs 91 [60.3%], respectively). A score of 0 on the hf-PGA was achieved by 153 participants (75%) in the guselkumab group compared with 76 (50.3%) in the adalimumab group.
In addition, 196 participants (46.7%) in the guselkumab group achieved an f-PGA score of 0 or 1 compared with 32 participants (15.2%) in the placebo group at week 16. A total of 252 participants (60%) in the guselkumab group achieved f-PGA score of 0 or 1 compared with 191 (64.3%) in the adalimumab group at week 24. A f-PGA score of 0 was achieved by 115 participants (27.4%) in the guselkumab group compared with 83 (27.9%) in the adalimumab group.
“These results may help dermatologists make treatment decisions for patients with psoriasis in difficult-to-treat body regions,” the researchers concluded.
Reference
Foley P, Gordon K, Griffiths CEM, et al. Efficacy of guselkumab compared with adalimumab and placebo for psoriasis in specific body regions: a secondary analysis of 2 randomized clinical trials [published online May 16, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.0793.
