Tremfya outperforms IL-17 inhibitors in treatment persistence for plaque psoriasis

Key takeaways:

• Tremfya showed greater persistence in bio-naïve and bio-experienced patients with plaque psoriasis vs. interleukin-17 inhibitors.
• In a post-hoc analysis, Tremfya improved scalp psoriasis by week 48.

Tremfya demonstrated greater treatment persistence than interleukin-17 inhibitors in patients with moderate to severe plaque psoriasis and achieved clinical efficacy in scalp psoriasis, according to data presented here.

Tremfya (guselkumab, Janssen Biotech) is the first and only fully human selective interleukin (IL)-23 approved in the United States for adults with moderate to severe plaque psoriasis. The pairwise analyses of this drug among bio-naïve and bio-experienced patients, in addition to a study looking at the drug’s efficacy in scalp psoriasis, were presented at the American Academy of Dermatology Annual Meeting.

“We now have many treatments for patients with moderate to severe psoriasis, and we need to know which treatments are the best,” Steven Feldman, MD, dermatologist at the Wake Forest University School of Medicine, told Healio. “Clinical trials are not fully informative. The experience of real-life patients as determined from insurance claims data can be complementary to what we learned from clinical trials.”

Steven Feldman

The results showed that guselkumab was associated with greater persistence, defined as longer median time to index treatment discontinuation, compared with secukinumab and ixekizumab.

Bio-naïve patient data

In comparison with secukinumab, bio-naïve patients taking guselkumab (n = 2,202) demonstrated a higher probability of persistence compared with those taking secukinumab (n = 2,772). At 12 months, this difference between guselkumab and secukinumab was 69.6% vs. 44.5% (P < .001), and at 18 months the difference was 63.1% vs. 33.1% (P < .001).

Further, guselkumab demonstrated a longer median time of persistence compared with secukinumab (32.8 months vs. 10.5 months, respectively). Guselkumab also showed 2.2 times longer persistence at 12 months and 2.28 times longer resistance at 18 months vs. the secukinumab group (P < .001 for both).

When comparing patients taking guselkumab (n = 2,241) and ixekizumab (n = 2,007), probability of persistence was higher for guselkumab at both 12 months (69.2% vs. 50.9%; P < .001) and 18 months (62.5% vs. 41.2%; P < .001). At 32.3 months, the median time of persistence was longer with guselkumab vs. ixekizumab (12.3 months). The guselkumab group also showed 1.84 times and 1.86 times longer resistance at 12 and 18 months, respectively, compared with the ixekizumab group (P < .001 for both).

Bio-experienced patient data

Similar results were seen among bio-experienced patients, with the guselkumab cohort (n = 1,314) demonstrating 2 times and 2.04 times longer persistence vs. the secukinumab cohort (n = 3,294) at 12 and 18 months (P < .001 for both). At 12 months, guselkumab had a higher probability of persistence compared with secukinumab (68.3% vs. 46.3%; P < .001), a pattern that continued at 18 months (59.1% vs. 33%; P < .001). Guselkumab exhibited a median time of persistence of 26.2 months vs. 10.7 months for secukinumab.

Additionally, compared with the ixekizumab cohort (n = 2,667), the guselkumab cohort (n = 1,564) showed 1.76 and 1.67 times longer persistence at 12 and 18 months as well (P < .001 for both). Guselkumab also demonstrated higher probability of persistence compared with ixekizumab at both 12 months (67.7% vs. 52.1%; P < .001) and 18 months (58.4% vs. 43.8%; P < .001), as well as a longer median time of persistence (25.9 months vs. 13 months).

“While IL-17 inhibitors may work faster than guselkumab in the first few weeks of treatment, this study finds that in the long run patients appear to have better long-term psoriasis control with guselkumab than with IL-17 blockade,” Feldman told Healio.

Scalp psoriasis results

Data from a post-hoc analysis of the phase 3 VOYAGE trial presented at the AAD Annual Meeting showed that, in comparison with adalimumab and placebo, patients with plaque psoriasis treated with guselkumab that experienced a 90% improvement from baseline and remained on treatment also showed increased scalp-specific IGA scores, from 2.9 at baseline to 0.2 at week 24 and 0.3 at week 48.

This group also demonstrated improved PASI and quality of life scores from baseline to week 24, stabilizing at week 48. PASI improved from 21.9 at baseline to 0.6 at week 24 and 1 at week 48, whereas quality of life scores improved from 14.9 at baseline to 2.1 at week 24 and 1.9 at week 48.

References:

• Savage L, et al. Poster. Guselkumab in patients with scalp psoriasis: A post hoc analysis of the VOYAGE 2 trial. Presented at: American Academy of Dermatology Annual Meeting; March 17-21, 2023; New Orleans.
• TREMFYA (guselkumab) Real-World Data Analyses Show Greater Treatment Persistence Than IL-17s in Both Bio-naïve and Bio-experienced Patients Living With Moderate to Severe Plaque Psoriasis. https://www.jnj.com/tremfya-guselkumab-real-world-data-analyses-show-greater-treatment-persistence-than-il-17s-in-both-bio-naive-and-bio-experienced-patients-living-with-moderate-to-severe-plaque-psoriasis. Published March 17, 2023. Accessed March 27, 2023.
• Zhdanava M, et al. Poster. Long term psoriasis control with guselkumab versus secukinumab and ixekizumab among bio-experienced patients: Analysis of drug persistence in large claims database. Presented at: American Academy of Dermatology Annual Meeting; March 17-21, 2023; New Orleans.