Research reveals the superiority of guselkumab over ustekinumab for psoriatic arthritis

A recent phase 3 trial findings, reported in Rheumatology and Therapy, indicated that both doses of guselkumab showcased superior efficacy compared to ustekinumab concerning joint and skin outcomes over 52 weeks in psoriatic arthritis (PsA) patients. 

Thilakarathne et al. conducted an in-depth analysis by combining individual patient data (IPD) from trials involving guselkumab (DISCOVER-1 and -2) and ustekinumab (PSUMMIT 1 and 2). They examined baseline characteristics, American College of Rheumatology (ACR) scores, and Psoriasis Area Severity Index (PASI) responses. The study found similar baseline characteristics between patients treated with guselkumab (100 mg every 8 weeks [Q8W] or 100 mg every 4 weeks [Q4W]) and those treated with ustekinumab (45/90 mg). 

In patients naive to biologic treatments, both guselkumab doses showed better results in ACR 20 and PASI 90 responses compared to ustekinumab starting from week 16. Among patients who had previous biologic treatment, guselkumab also performed better in ACR 20 responses from week 24 onwards. Guselkumab outperformed ustekinumab in PASI 90 responses at weeks 16 and 52. The study concluded that guselkumab consistently demonstrated strong effectiveness across various analyses. 

The landscape of treatment for PsA has undergone significant transition from traditional disease-modifying antirheumatic drugs (DMARDs) to targeted synthetic and biologic DMARDs. Among these, biologic therapies targeting interleukin (IL) pathways, notably IL-23 and IL-12/23 inhibitors, have emerged as effective treatments for improving both joint and skin outcomes in PsA. Guselkumab, a fully human immunoglobulin G1 (IgG1) lambda monoclonal antibody, selectively binds to the p19 subunit of IL-23, while ustekinumab, another fully human monoclonal antibody, targets the shared p40 subunit of both IL-12 and IL-23. These targeted therapies represent a significant advancement in managing PsA, offering promising avenues for improved patient outcomes 

The study findings highlight the effectiveness of both guselkumab doses compared to ustekinumab in improving joint and skin outcomes over a 52-week period among PsA patients. However, it is imperative that future research endeavors extend beyond this timeframe to comprehensively evaluate the long-term comparative efficacy of these treatments. Such investigations will be instrumental in providing a more thorough understanding of their sustained benefits and guiding clinical decision-making for optimal PsA management. 

 Reference 

Thilakarathne P, Schubert A, Peterson S, Noel W, Patel BP, Hassan F. Comparing Efficacy of Guselkumab versus Ustekinumab in Patients with Psoriatic Arthritis: An Adjusted Comparison Using Individual Patient Data from the DISCOVER and PSUMMIT Trials. Rheumatol Ther. 2024 Feb 28. 

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