Medicine Matters rheumatology

They offer another treatment option for patients with psoriatic arthritis, which is the first thing. It does look like guselkumab results in a significant improvement in the primary outcome measure of the ACR20 measure in both the DISCOVER-1 and DISCOVER-2 trials. DISCOVER-1 being patients who were previously exposed to a TNF inhibitor-- or included patients who were previously exposed to a TNF inhibitor. Whereas the DISCOVER-2 includes the whole question of effect on radiographic outcomes. So it works for both, and both groups of patients.

And it works for all the aspects of disease, not just joint disease. It looks like it's particularly effective for skin disease, which isn't surprising given the data in psoriasis. But other features, like enthesitis and dactylitis also significantly improve with many patients reaching dactylitis and enthesitis scores of zero, complete resolution with guselkumab.

It compares favorably with other treatments. Because of its effect on skin disease-- they haven't been compared head to head-- but it's likely to be more efficacious than some of the treatments that are currently available in terms of that particular aspect. So I can certainly see if a patient has a lot of skin disease, that guselkumab would be a reasonable medication to choose.

I guess one of the challenges is, you know, for other aspects of disease, how do we know that guselkumab is going to be the best choice for those patients. The data would suggest that it also, as I say, works well for patients who have dactylitis and enthesitis. So maybe patients who have bad skin disease, dactylitis, enthesitis, and joint disease-- maybe they're the ones to focus on.

The first biologic that was approved for treatment on psoriatic arthritis are the anti-TNF inhibitors, as you know. And they've always been a hard group to compare with. Because they have been very effective over many years and many people feel comfortable with using anti-TNFs. But I suspect that over time, guselkumab-- there will be good take up of guselkumab within the psoriatic arthritis community. In particular, as people-- as dermatologists are using it in patients with psoriasis, rheumatologists would become more familiar with it and more comfortable with it. So I think I think it will certainly have an impact on the landscape for what we're using.

I think it's great news. We have yet another choice. We need to understand better-- to answer your question-- which patients we should be using which drug in. And that, I think, is the big challenge for us at the present. Now with this large group of medications that we have available for psoriatic arthritis is how to select out which treatment is going to work for which individual patients. So that's going to be a particular focus, I think, over the next few years.