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Guselkumab in patients with residual mild psoriasis following treatment with ustekinumab: Post hoc analysis from the NAVIGATE trial
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In the phase III NAVIGATE trial (NCT02203032), adult patients with moderate-to-severe plaque psoriasis were treated with ustekinumab over 16 weeks.1 At Week 16, response was assessed and patients with an inadequate response were randomized 1:1 to receive guselkumab or continue ustekinumab. A post hoc analysis of this trial assessed outcomes in patients with residual mild psoriasis, defined as an Investigator’s Global Assessment score of 2, at Week 16 (n = 161). Results from this analysis were published in Acta Dermato-Venereologica by Errichetti et al.1
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| Key learnings |
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In patients with residual mild psoriasis, switching to guselkumab vs continuing ustekinumab resulted in higher PASI 90 (47.4% vs 31.3%) and PASI 100 (10.3% vs 7.2%) response rates at Week 24. These response rates with guselkumab were maintained at Week 52 (PASI 90, 59.0% vs 26.5%; PASI 100, 21.8% vs 9.6%). |
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Patients switching to guselkumab experienced greater improvements in DLQI, with 50% achieving a DLQI of 0 or 1, compared with 21% on ustekinumab, at Week 28. Differences in treatment favoring guselkumab were maintained through Week 52. |
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Guselkumab-treated patients reported more meaningful reductions in psoriasis symptoms compared with those treated with ustekinumab. At Week 28, the differences in change from baseline in PSSD Symptoms and Signs scores were 17.1 and 15.7 for guselkumab and ustekinumab, respectively. Additionally, mean improvements in combined PSSD Symptoms and Signs scores exceeded the clinically meaningful threshold (≥40) at all time points assessed in guselkumab-treated patients, whereas these thresholds were generally not met in patients continuing ustekinumab. |
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These findings suggest that in patients with residual mild psoriasis after 16 weeks treatment with ustekinumab, switching to guselkumab could improve outcomes, supporting treatment adjustments in clinical practice. |
Abbreviations: DLQI, Dermatology Life Quality Index; PASI, Psoriasis Area and Severity Index; PSSD, Psoriasis Symptoms and Signs Diary.
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