Guselkumab Superior to Ustekinumab for Achieving, Maintaining Treatment Response in Plaque Psoriasis

plaque psoriasis on chest
plaque psoriasis on chest
In a novel head-to-head study comparing guselkumab and ustekinumab in both biologic-naive and experienced patients, guselkumab demonstrated a significantly higher probability of achieving and maintaining PASI treatment response through week 40 compared with ustekinumab.

Guselkumab, an interleukin 23 inhibitor, may be more effective than ustekinumab for helping patients with moderate to severe plaque psoriasis achieve and maintain treatment response through 40 weeks, research published in the British Journal of Dermatology suggests.

The study was an assessment of individual patient data for guselkumab from the VOYAGE 1 and 2 trials (n=825). Data were pooled and compared with individual patient data for ustekinumab from the NAVIGATE trial (n=853). Using multivariable logistic regression analyses, researchers compared guselkumab 100 mg with ustekinumab 45 mg/90 mg for achieving and maintaining Psoriasis Area and Severity Index (PASI) 90, 75, and 100 up to week 40. Analyses were adjusted for age, sex, and psoriasis duration.

In the pooled and adjusted analysis, treatment with guselkumab was associated with a significantly greater probability of patients achieving a PASI 90 response at week 16 compared with treatment with ustekinumab (70.4% vs 46.0%, respectively; odds ratio [OR], 2.79; 95% CI, 2.22-3.45). At week 40, there was also a higher probability of patients achieving a PASI 90 response with guselkumab (74.2% vs 54.5%; OR, 2.40; 95% CI, 1.89-3.13). Treatment with guselkumab was also associated with a significantly greater likelihood of achieving PASI 75 at week 40 (OR, 2.14; 95% CI, 1.54-2.94), as well as PASI 100 responses at week 40 (OR, 2.53; 95% CI, 2.00-3.23).

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A limitation of the study was the potential for unknown, unadjusted characteristics in the VOYAGE and NAVIGATE trials that could have affected PASI response.

“Future studies are needed to assess the long-term comparative efficacy of guselkumab relative to ustekinumab and other treatments beyond 40 weeks,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Diels J, Thilakarathne P, Cameron C, et al. Adjusted treatment COMPArisons between guSelkumab and uStekinumab for treatment of moderate-to-severe plaque psoriasis: the COMPASS Analysis [published online October 25, 2019]. Br J Dermatol. doi:10.1111/bjd.18634