In both biologic-naïve and tumor necrosis factor inhibitor (TNF)-experienced patients with psoriatic arthritis (PsA), a higher proportion of patients treated with guselkumab experienced ≥1-level improvement in the Health Assessment Questionnaire-Disability Index (HAQ-DI) items deemed most impaired at baseline when compared with placebo, according to research presented at the 2023 Congress of Clinical Rheumatology West. These improvements were seen as early as week 4 (1 dose) and continued to improve through week 24 in patients receiving guselkumab every 4 weeks (Q4W) and every 8 weeks (Q8W).

Proton Rahman, MD

Credit: The Journal of Canadian Rheumatology Association

“Maintaining daily activities is a critical treatment goal for patients with PsA, who have emphasized the importance of communicating the timing and extent to which a treatment may improve their function,” wrote lead investigator Proton Rahman, MD, rheumatologist and genetic epidemiologist at the Craig L Dobbin Genetics Research Centre, Memorial University of Newfoundland, St John’s, Canada, and colleagues.

In this post hoc analysis of the phase 3 DISCOVER-1 and DISCOVER-2 trials, guselkumab, a fully human interleukin (IL)-23p19 subunit inhibitor, was assessed in both TNF-experienced and biologic-naïve patients to better understand the effect the treatment has on daily activities.

The DISCOVER-1 trial enrolled 381 patients and randomized them 1:1:1 to receive either guselkumab 100 mg at week 0, week 4, and then Q4W (n = 373); guselkumab 100 mg at week 0, week 4, and then Q8W (n = 375); or placebo (n = 372) for a total of 60 weeks. The DISCOVER-2 trial enrolled 739 patients, randomized 1:1:1 with the same dosages, for a total of 112 weeks.

The HAQ-DI is a tool used to evaluate the physical function of patients using 20 common activities of daily living. Patients rated these items on a scale of 0 – 3, with 0 defined as no difficulty performing an activity and 3 defined as being unable to perform the task. The ability to achieve ≥1 or ≥2 level improvement was compared between the guselkumab-treated groups and the placebo cohort using logistic regression, adjusting for prior TNF use, baseline values, and baseline disease-modifying antirheumatic drug (DMARD) use.

Impairment was measured by the ability to do chores, dress themselves, get in and out of bed, climb up 5 stairs, reach for and retrieve a 5 lb object above their head, and bend down to pick up clothes from the floor. For most HAQ-DI items, the mean scores at baseline ranged from .7 – .9 across treatment groups. The lowest levels of impairment at baseline were the ability to lift a full cup or glass to mouth, open car doors, and turn faucets on and off.

Scores of ≥1 were reported by >50 – 70% of pooled patients regarding items such as being able to take a tub bath, open previously opened jars, stand up from a straight chair, run errands and shop, walk outdoors on flat ground, open a new milk carton, get in and out of a car, shampoo their hair, and wash/dry their body.

For HAQ-DI items most impaired at baseline, a higher number of patients receiving guselkumab treatment reported ≥1 improvement as early as week 4, which continued to improve through week 24.

“Results of these analyses, which showed guselkumab provided early improvements in daily activities reported to be the most impaired by these patients may assist the communication between patients and healthcare providers when establishing treatment goals during shared decision making,” investigators concluded.

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