Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Guselkumab Improves Psoriatic Arthritis Regardless of Prior TNFi Use

Key clinical point: Guselkumab showed efficacy versus placebo for active PsA in both biologic-naive and tumor necrosis factor inhibitor–treated patients.

Major finding: American College of Rheumatology 20 at 24 weeks was achieved by 58.6%, 52.8%, and 22.2% of patients in the guselkumab 4- and 8-week dosing groups and the placebo group, respectively.

Study details: A randomized, double-blind, placebo-controlled, phase 3 study of 381 patients.

Disclosures: DISCOVER-1 was funded by Janssen Research & Development. Dr. Deodhar reported relationships (advisory board activity, consulting, and/or research grant funding) with several pharmaceutical companies, including Janssen. Several coauthors are employees of Janssen.


Deodhar A et al. Arthritis Rheumatol. 2019;71(suppl 10), Abstract 807.


Currently IL-23 blockers are not approved for the treatment of psoriatic arthritis. However, this study demonstrated that guselkumab was effective at reducing psoriatic arthritis severity and improving physical function. The inhibition of the progression of arthritis—radiographically based on joint space narrowing and erosions—remains to be determined. Nonetheless, these results suggest that an IL-23 blocker, such as guselkumab, may be an effective treatment for psoriatic arthritis. Approval for this indication is pending.—Paul S. Yamauchi, MD, PhD; Clinical Assistant Professor of Dermatology David Geffen School of Medicine at UCLA; Harbor-UCLA Medical Center Division of Dermatology; Adjunct Associate Professor John Wayne Cancer Institute.