In a recent article, investigators described their post hoc analysis of DISCOVER-2, a phase 3 randomized controlled trial that evaluated guselkumab therapy for up to 2 years in patients with psoriatic arthritis. They explored whether radiographic progression during treatment had any associations with clinical outcomes after treatment.
Based on their results, the researchers associated more favorable efficacy outcomes, including low level and minimal disease activity, with participants who did not have radiographic progression during treatment. The study’s findings were presented in RMD Open.
Radiographic Progression Predicts Guselkumab Outcomes
The analysis population consisted of 664 out of 739 participants from DISCOVER-2 who continued treatment at week 52. The interventions were guselkumab 100 mg every 4 weeks (Q4W) and guselkumab 100 mg at week 0, 4, and then every 8 weeks (Q8W).
Researchers evaluated hand and feet radiographs from weeks 0, 24, 52, and 100 using a modified van der Heijde-Sharp (vdH-S) method, with disease progression defined as >0.5 change in total vdH-S score. Efficacy outcomes in the original trial were based on American College of Rheumatology, Disease Activity in Psoriatic Arthritis, Psoriatic Arthritis Disease Activity Score, and Health Assessment Questionnaire-Disability Index criterias
Reportedly, the Q4W and Q8W groups had mean changes in vdH-S of 1.7 and 1.5, respectively, after 100 weeks of guselkumab treatment. Notably, mean changes in vdH-S score were lower among patients with successful clinical response, disease activity, and physical function outcomes compared with patients who did not succeed on guselkumab.
In addition, patients without radiographic progression were more likely to achieve minimal disease activity thresholds for swollen and tender joints, patient-reported pain and global assessment outcomes, and normalized physical function through week 100.
In closing, the report’s authors suggested “these results underscore the importance of timely treatment for PsA and suggest that optimising treatment decisions to achieve low levels of disease activity across multiple PsA domains may ultimately improve long-term structural damage outcomes, thus preserving overall physical function.”
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