Evaluating guselkumab in psoriatic arthritis

Summary: Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting approximately 30% of individuals with psoriasis. The IL-23/Th17 pathway plays a central role in PsA pathogenesis, driving inflammation and joint damage. Guselkumab, a human monoclonal antibody targeting the IL-23 p19 subunit, offers a novel therapeutic approach by selectively inhibiting IL-23 signaling, thereby reducing Th17-driven cytokine production. This review aims to evaluate the therapeutic potential of guselkumab based on recent clinical trial data. A comprehensive literature search was conducted using PubMed, focusing on clinical trials that examined the use of guselkumab in PsA up to September 1, 2024. After applying exclusion criteria, nine randomized controlled trials (RCTs) were included in the review. These trials assessed key efficacy endpoints, including ACR20, ACR50, and ACR70 responses, as well as secondary outcomes such as patient-reported quality of life measures and work productivity indices. ACR20 response rates ranged from 44% to 76% in patients receiving guselkumab, compared to 20% to 33% in placebo groups. Similarly, ACR50 and ACR70 response rates showed consistent improvements over time, reflecting its ability to control disease activity effectively. In addition to its impact on clinical symptoms, guselkumab was associated with enhanced work productivity, reduced presenteeism, and improved overall quality of life scores, reinforcing its broader benefits beyond disease control. The most commonly reported side effects included nasopharyngitis, upper respiratory infections, and headaches, while serious adverse events were infrequent. Overall, guselkumab's selective IL-23 inhibition offers distinct advantages over existing biologics, supporting its role as an effective and well-tolerated treatment option. Future research should explore long-term outcomes, comparative efficacy with other biologics, and biomarker-driven treatment personalization. Alisha Kashyap¹, Kevin Burningham¹, Stephen Tyring¹ 1. The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, TX, United States. Adaptive and Auto-Immunity