Guselkumab May Have Edge Over Secukinumab in Long-Term Control of Psoriasis

By Reuters Staff

August 17, 2019

NEW YORK (Reuters Health) - For moderate-to-severe plaque psoriasis, treatment with guselkumab was superior to secukinumab based on 90% or better improvement from baseline in patients' Psoriasis Area and Severity Index score (PASI 90) at 48 weeks in the ECLIPSE study.

The study was funded by Janssen, which markets guselkumab as Tremfya. Novartis markets secukinumab under the brand name Cosentyx.

Antibodies targeting interleukin (IL)-23 and IL-17A are both effective in treating moderate-to-severe psoriasis. ECLIPSE is the first head-to-head comparison of an IL-23p19 inhibitor (guselkumab) and an IL-17A inhibitor (secukinumab), Dr. Kristian Reich of University Medical Center Hamburg-Eppendorf, in Germany, and colleagues note in The Lancet, online August 8.

In this phase 3 study, adults with moderate-to-severe plaque psoriasis were randomly assigned to guselkumab (n=534; 100 mg at weeks 0 and 4 then every eight weeks) or secukinumab (n=514; 300 mg at weeks 0, 1, 2, 3, and 4, and then every four weeks).

Between week 3 and week 12, the proportions of patients achieving a PASI 90 response were higher in the secukinumab group than in the guselkumab group; at weeks 16 and 20 they were similar in the two groups; and from week 28 to 48 they were higher in the guselkumab group, the investigators report.

The proportion of patients who achieved a PASI 90 response at week 48 (the primary endpoint) was greater in the guselkumab arm than the secukinumab arm (84% vs. 70%; P<0.0001).

However, guselkumab was not statistically superior to secukinumab with regard to the proportion of patients who achieved PASI 75 responses at both 12 and 48 weeks, a major secondary end point, which was met by 85% of the guselkumab group and 80% of the secukinumab group (P=0.0616).

"Consequently, formal statistical testing was not done for subsequent major secondary endpoints," the researchers note, namely a PASI 90 response at week 12, a PASI 75 response at week 12, a PASI 100 response at week 48, an Investigator's Global Assessment score of 0 (cleared) at week 48, and an IGA score of 0 or 1 (minimal) at week 48.

Both drugs were well tolerated, with no differences in the proportions of patients with adverse events, infections, and serious adverse events; in general, safety findings were consistent with prior studies, the researchers say.

Summing up, the study team says, "The ECLIPSE study provides a comparison between the most effective classes of biologics used for treating moderate-to-severe psoriasis - generating valuable data for understanding the timeline and extent of efficacy of targeting IL-23p19 versus IL-17A - as well as a comparative safety profile, for a duration of nearly 1 year. These findings should assist healthcare providers in their decision making process when selecting a biologic for treating moderate-to-severe psoriasis."

Novartis did not respond to a request for comment by press time.

Several authors have disclosed relationships with Janssen, Novartis and other pharmaceutical companies.


Lancet 2019.