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Eyerich K, Asadullah K, Pinter A, Weisenseel P, Reich K, Paul C, Sabat R, Wolk K, Eyerich S, Lauffer F, Angsana J, Taut FJH, Kohler K, Chen Y, Sendecki J, Leung MWL, Wegner S, Personke Y, Gomez M, Krüger N, Tabori S, Schäkel K. Noninferiority of 16-Week vs 8-Week Guselkumab Dosing in Super Responders for Maintaining Control of Psoriasis: The GUIDE Randomized Clinical Trial. JAMA Dermatol 2024; 160:953-963. [PMID: 39083288 PMCID: PMC11292573 DOI: 10.1001/jamadermatol.2024.2463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/04/2024] [Indexed: 08/03/2024]
Abstract
Importance Psoriasis is a chronic inflammatory skin disease with unmet needs for tailored treatment and therapy de-escalation strategies. Objective To evaluate early intervention with and prolonging the dosing interval for guselkumab, a p19 subunit-targeted interleukin (IL)-23 inhibitor, in patients with moderate to severe psoriasis. Design, Setting, and Participants The GUIDE clinical trial is an ongoing phase 3b, randomized, double-blinded trial conducted across 80 centers in Germany and France comprising 3 parts evaluating the impact of early disease intervention, prolonged dosing interval, and maintenance of response following treatment withdrawal among adults with moderate to severe plaque psoriasis. In study part 2, reported herein, first and last patient visits were September 2019 and March 2022, respectively. Interventions In GUIDE part 1 (week [W]0-W28), patients received guselkumab, 100 mg, at W0, W4, W12, and W20. Those achieving a Psoriasis Area and Severity Index (PASI) of 0 at both W20 and W28 were termed super responders (SRes). In part 2 (W28-W68), SRes were randomized to guselkumab, 100 mg, every 8 weeks or every 16 weeks; non-SRes continued open-label guselkumab every 8 weeks. Main Outcomes and Measures Primary objective was to demonstrate noninferiority (with a 10% margin) of guselkumab every 16 weeks vs every 8 weeks dosing among SRes for maintenance of disease control (PASI <3 at W68). Biomarker substudies assessed immunologic effects in skin and blood. Results Overall, 822 patients received guselkumab in part 2 (297 [36.1%] SRes [every 8 weeks/every 16 weeks; n = 148/n = 149] and 525 [63.9%] non-SRes). Among SRes, mean (SD) age was 39.4 (14.1) years, 95 (32.0%) were female, and 202 (68.0%) were male. The primary end point of noninferiority for guselkumab every 16 weeks vs every 8 weeks in SRes was met (P = .001), with 91.9% (137/149; 90% CI, 87.3%-95.3%) of SRes receiving every 16 weeks and 92.6% (137/148; 90% CI, 88.0%-95.8%) of SRes receiving dosing every 8 weeks having PASI lower than 3 at W68. Clinical effects corresponded with immunologic changes; skin CD8-positive tissue-resident memory T (TRM)-cell count decreased quickly from baseline, remaining low in both dosing groups. Similarly, serum IL-17A, IL-17F, IL-22, and β defensin (BD)-2 levels decreased significantly from baseline, remaining low in both dosing groups to W68. Guselkumab was well-tolerated; no new safety signals were identified. Conclusions and Relevance Psoriasis treatment guidelines lack or provide inconsistent advice on patient stratification and treatment de-escalation. We present the first randomized trial providing evidence that, in patients with early complete skin clearance at 2 consecutive visits (W20 and W28), extending the guselkumab dosing interval may control disease activity. Trial Registration ClinicalTrials.gov Identifier: NCT03818035.
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Affiliation(s)
- Kilian Eyerich
- Department of Dermatology and Venereology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Khusru Asadullah
- Department of Dermatology, Venereology and Allergology, Charité – Universitätsmedizin, Berlin, Germany
- Dermatology Potsdam MVZ, Potsdam, Germany
| | - Andreas Pinter
- University Hospital Frankfurt am Main, Frankfurt, Germany
| | | | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Robert Sabat
- Psoriasis Research and Treatment Center, Department of Dermatology, Venereology and Allergology, and Institute of Medical Immunology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kerstin Wolk
- Psoriasis Research and Treatment Center, Department of Dermatology, Venereology and Allergology, and Institute of Medical Immunology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefanie Eyerich
- Center for Allergy and Environment, Technical University and Helmholtz Center Munich, Munich, Germany
| | - Felix Lauffer
- Center for Allergy and Environment, Technical University and Helmholtz Center Munich, Munich, Germany
| | | | | | | | | | | | | | | | | | - Mario Gomez
- Janssen Global Services LLC, Horsham, Pennsylvania
| | | | | | - Knut Schäkel
- Department of Dermatology, and Interdisciplinary Center for Inflammatory Diseases, Heidelberg University Hospital, Heidelberg, Germany
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Marcelli L, Belcastro A, Talamonti M, Paganini C, Fico A, Savastano L, Di Raimondo C, Vellucci L, Bianchi L, Galluzzo M. Characterization of Super-Responder Profile in Chronic Plaque Psoriatic Patients under Guselkumab Treatment: A Long-Term Real-Life Experience. J Clin Med 2024; 13:5175. [PMID: 39274388 PMCID: PMC11396162 DOI: 10.3390/jcm13175175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/16/2024] Open
Abstract
Background: The term "super responder" identifies a group of patients who exhibit a rapid and optimal response to biological treatment compared to the overall treated population. The primary objective of our study is to characterize this subgroup of patients to enable the early identification of those who will respond most effectively to the proposed treatment while also evaluating clinical efficacy. Methods: This retrospective study evaluated 232 patients treated with guselkumab in monotherapy for at least 20 weeks between November 2018 and November 2023. Patients were divided into two groups: those who achieved complete clear skin (PASI = 0) during the first 20 weeks of treatment were defined as super responders (SRe) and non-super responders (nSRe) were the remaining patients. PASI was assessed at weeks 0, 4, and subsequently every eight weeks. Predictors of the SRe status were evaluated by univariate and multivariate logistic regression analyses. Results: The univariate analyses showed that patients with psoriatic arthritis at the baseline, bio-naïve patients, or those who had not received an interleukin (IL) 17 inhibitor as their last therapy before guselkumab administration were more likely to be super responders to the proposed treatment. Multivariate logistic analysis models suggested that the combination of psoriatic arthritis at the baseline and the bio-naïve condition was the strongest predictive model for the SRe status. At week 204, the main difference between the two groups concerned the achievement of PASI100, maintained by 86.8 of SRe compared to 62.8% of nSRe. Conclusions: The efficacy and safety of guselkumab are confirmed in our real-life experience. Identifying the SRe status will undoubtedly play a role in clinical practice and the therapeutic decision-making algorithm.
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Affiliation(s)
- Lorenzo Marcelli
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Alfredo Belcastro
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Marina Talamonti
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", 00133 Rome, Italy
| | - Claudia Paganini
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Angela Fico
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Lorenzo Savastano
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Cosimo Di Raimondo
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", 00133 Rome, Italy
| | - Laura Vellucci
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Luca Bianchi
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", 00133 Rome, Italy
| | - Marco Galluzzo
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", 00133 Rome, Italy
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Thomas SE, Barenbrug L, Hannink G, Seyger MMB, de Jong EMGJ, van den Reek JMPA. Drug Survival of IL-17 and IL-23 Inhibitors for Psoriasis: A Systematic Review and Meta-Analysis. Drugs 2024; 84:565-578. [PMID: 38630365 PMCID: PMC11190018 DOI: 10.1007/s40265-024-02028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND AND OBJECTIVE The most recently approved biologics for moderate-to-severe psoriasis are the interleukin (IL)-17 and IL-23 inhibitors. Drug survival is a frequently used outcome to assess drug performance in practice. An overview of the available drug survival studies regarding IL-17 and IL-23 inhibitors is lacking. Therefore, our objective was to assess the drug survival of IL-17 and IL-23 inhibitors for psoriasis. METHODS A search of PubMed, Embase, Cochrane Library and Web of Science was conducted (last search 27 December, 2023). Inclusion criteria were (1) cohort study; (2) patients aged ≥ 18 years with plaque psoriasis; and (3) evaluation of drug survival of at least one of the IL-17 and IL-23 inhibitors. Exclusion criteria were: primary focus on patients with psoriatic arthritis, fewer than ten study subjects and another language than English. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Survival probabilities at monthly intervals were extracted from Kaplan-Meier curves using a semi-automated tool. Data were pooled using a non-parametric random-effects model to retrieve distribution-free summary survival curves. Summary drug survival curves were constructed per biologic for different discontinuation reasons: overall, ineffectiveness and adverse events, and split for the effect modifier biologic naivety. Results were analysed separately for registry/electronic health record data and for pharmacy/claims data. RESULTS A total of 69 studies aggregating drug survival outcomes of 48,704 patients on secukinumab, ixekizumab, brodalumab, guselkumab, risankizumab, and tildrakizumab were included. Summary drug survival estimates of registry/electronic health record studies for overall, ineffectiveness and adverse event related drug survival were high (all point estimates ≥ 0.8 at year 1) for included biologics, with highest estimates for guselkumab and risankizumab. All estimates for drug survival were higher in biologic naive than in experienced patients. Estimates of pharmacy/claims databases were substantially lower than estimates from the primary analyses based on registry/electronic health record data. CONCLUSIONS This meta-analysis showed that the investigated IL-17 and IL-23 inhibitors had high drug survival rates, with highest rates for guselkumab and risankizumab drug survival. We showed that effect modifiers such as biologic naivety, and the source of data used (registry/electronic health record data vs pharmacy/claims databases) is relevant when interpreting drug survival studies.
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Affiliation(s)
- Sarah E Thomas
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Mailbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Liana Barenbrug
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Mailbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Centre (Radboudumc), Nijmegen, The Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Mailbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Mailbox 9101, 6500 HB, Nijmegen, The Netherlands
- Radboud University, Nijmegen, The Netherlands
| | - Juul M P A van den Reek
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Mailbox 9101, 6500 HB, Nijmegen, The Netherlands
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Rodriguez Goicoechea M, Tejedor Tejada E, Borrás Blasco J. [Translated article] Persistence: The current state of the art. FARMACIA HOSPITALARIA 2024; 48:T141. [PMID: 38679533 DOI: 10.1016/j.farma.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 05/01/2024] Open
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Rodriguez Goicoechea M, Tejedor Tejada E, Borrás Blasco J. Persistence, current state of the art. FARMACIA HOSPITALARIA 2024; 48:141. [PMID: 37758639 DOI: 10.1016/j.farma.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 09/29/2023] Open
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van Riel CAM, Michielsens CAJ, van Muijen ME, van der Schoot LS, van den Reek JMPA, de Jong EMGJ. Dose reduction of biologics in patients with plaque psoriasis: a review. Front Pharmacol 2024; 15:1369805. [PMID: 38606178 PMCID: PMC11007084 DOI: 10.3389/fphar.2024.1369805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
Dose reduction (DR) of first-generation biologics for plaque psoriasis (TNF-alpha inhibitors (i) and interleukin (IL)-12/23i) has been described in a previous scoping review. The literature on the DR of the newest generation of biologics (IL-17/23i) was scarce. The current review provides a literature update on the previous scoping review on the DR of all biologics, including the newest generation, with a focus on the uptake and implementation of DR in practice. The current literature search on DR revealed 14 new articles in addition to those in the previous review. Four of the newly found articles tested DR strategies, mostly focusing on first-generation biologics; only guselkumab (IL-23i) was included in one study. The other 10 studies showed data on regaining response after failure of DR, safety, cost-effectiveness, and uptake and implementation, as well as information about IL-17/23i. The eligibility criteria to start DR included both absolute and relative Psoriasis Area and Severity Index (PASI) scores (PASI ≤3/≤5/PASI 75-100) and/or Dermatology Life Quality Index (DLQI) ≤3/≤5, or BSA ≤1/≤2, or Physician Global Assessment (PGA) ≤1/0-2 during a period ranging from 12 weeks to ≥1 year. Most studies used PASI ≤5 and/or DLQI ≤5 or PGA ≤1 for ≥6 months. DR strategies were mostly performed by stepwise interval prolongation in two steps (to 67% of the standard dose, followed by 50%). Some studies of IL-17/23i reduced the dose to ±25%. The tested DR strategies on stepwise or fixed DR on TNF-αi and IL-12/23i (three studies), as well as one "on-demand" dosing study on IL-23i guselkumab, were successful. In the case of relapse of DR on TNF-αi and IL-12/23i, clinical effectiveness was regained by retreatment with the standard dose. All studies showed substantial cost savings with the biologic DR of TNF-αi and IL-12/23i. The identified barriers against the implementation of DR were mainly a lack of guidelines and scientific evidence on effectiveness and safety, and a lack of time and (technical) support. The identified facilitators were mainly clear guidelines, feasible protocols, adequate education of patients and physicians, and cost reduction. In conclusion, DR seems promising, but a research gap still exists in randomized, prospective studies testing DR strategies, especially of IL-17/23i, hampering the completion of guidelines on DR. Taking into account the identified barriers and facilitators most likely results in a more successful implementation of biologic DR in practice.
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Affiliation(s)
- C. A. M. van Riel
- Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
| | - C. A. J. Michielsens
- Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
| | - M. E. van Muijen
- Maastricht University Medical Centre, Maastricht, Limburg, Netherlands
- Department of Dermatology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands, Netherlands
| | - L. S. van der Schoot
- Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
| | - J. M. P. A. van den Reek
- Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
| | - E. M. G. J. de Jong
- Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
- Radboud University, Nijmegen, Gelderland, Netherlands
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Ruiz-Villaverde R, Galan-Gutierrez M, Armario-Hita JC, Rodriguez-Fernandez-Freire L. Efficacy and Pharmacoeconomic Analysis in Real Clinical Practice Conditions of Patients with Plaque Psoriasis Treated with Guselkumab: A Retrospective Multicenter Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:321-323. [PMID: 37923077 DOI: 10.1016/j.ad.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/15/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Instituto Biosanitario de Granada (ibs.GRANADA), Granada, España.
| | - M Galan-Gutierrez
- Servicio de Dermatología, Hospital Universitario San Reina Sofía, IMIBIC, Córdoba, España
| | - J C Armario-Hita
- Servicio de Dermatología, Hospital Universitario de Puerto Real, Cádiz, España
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Ruiz-Villaverde R, Galan-Gutierrez M, Armario-Hita JC, Rodriguez-Fernandez-Freire L. [Translated article] Efficacy and Pharmacoeconomic Analysis in Real Clinical Practice Conditions of Patients with Plaque Psoriasis Treated with Guselkumab: A Retrospective Multicenter Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T321-T323. [PMID: 38242431 DOI: 10.1016/j.ad.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/01/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain.
| | - M Galan-Gutierrez
- Servicio de Dermatología, Hospital Universitario San Reina Sofía, IMIBIC, Córdoba, Spain
| | - J C Armario-Hita
- Servicio de Dermatología, Hospital Universitario de Puerto Real, Cádiz, Spain
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