New biologic enters fight against psoriasis

A new monoclonal antibody which targets interleukin-23 (IL-23) is now available in Malaysia. Guselkumab (TREMFYA™, Janssen Pharmaceutical Companies of Johnson & Johnson) is a subcutaneously injected agent that blocks the body’s inflammatory pathway, namely, IL-23.  

The new drug regimen involves two loading or starter doses—the first at the beginning of treatment and one more at the 4-week mark. Thereafter, the patient is given one injection every 8 weeks. Guselkumab provides a “consistent maintenance of efficacy” to patients, said Chin Keat Chyuan, managing director of Johnson & Johnson Malaysia.

In line with their efforts to increase awareness about psoriasis treatment, Chin announced the launch of their patient awareness programme called ‘PsO Much More’ to put the word out about guselkumab’s efficacy in patients afflicted by the disfiguring disease. Chin added: “Patients with psoriasis can certainly look forward to effectively manage their disease with lasting efficacy, regain their self-esteem and lead quality lives.”

Speaking at the launch, Dr Ch’ng Chin Chwen, a consultant dermatologist, said psoriasis requires personalized treatment for each patient. Factors affecting the treatment regimen include severity of disease, the type of psoriasis, general health status of patient, and burden of disease to the patient. Treatment options cover general areas such as topical agents, phototherapy, and finally, systemic agents.

Common topical agents are coal tar, corticosteroids, salicylic acid, calcipotriol, dithranol, and calcineurin inhibitors. Systemic agents include the standard immunosuppressants such as methotrexate, retinoids and cyclosporine; the newer small molecules, and most recently, the biologics. 

Also present at the launch, Dr Peter Ch’ng Wee Beng, a consultant dermatologist, spoke about the trials that provided the evidence base for guselkumab, namely the ECLIPSE* study, a randomized, double-blinded, comparator-controlled trial that proved the safety and efficacy of the drug in adult patients with moderate-to-severe plaque psoriasis. The study, involving 1,048 patients, showed that 84 percent of patients administered with guselkumab were found to have achieved at least 90 percent improvement in their baseline Psoriasis Area Severity Index (PASI 90) score at week 48. Additionally, 58 percent of patients on guselkumab also achieved PASI 100 response, which is 100 percent clearance of psoriasis, at week 48. [Lancet 2019;394:831–839] Further trials are ongoing for guselkumab in patients with psoriatic arthritis and Crohn’s disease.

VOYAGE 1** demonstrated the guselkumab’s long-term efficacy in which 82 percent of patients receiving treatment continuously achieved at least 90 percent improvement in the PASI 90 response at 4 years. Additionally, the study revealed guselkumab was well tolerated in patients with psoriasis. [Available at: https://doi.org/10.1080/09546634.2020.1782817 Accessed on 10 November]

* ECLIPSE: Guselkumab versus secukinumab for the treatment of moderate-to-severe psoriasis **VOYAGE 1: A study of guselkumab in the treatment of participants with moderate-to-severe plaque-type psoriasis