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Guselkumab: widened action in psoriatic disease

Abstract:

Immunobiological therapy has been one of the greatest accomplishments in the field of medicine in recent years, leading to the improvement of the quality of life and clinical improvement in millions of patients. Physiopathogenesis has been extensively studied and dermatologists have played an important role in investigating this process. Therapeutic innovations arrived for psoriasis patients in a secondary way, where comorbidities had the treatment rationale for themselves. Fortunately, the priorities of immunobiological research changed this perspective, leading to the development of several new drugs for dermatological diseases as the first-line treatment. Blockade of interleukin (IL)-23 pro-inflammatory cytokine by anti-IL-23 specific sub-unit p19 monoclonal antibody, guselkumab, resulted in 4 years of safe and excellent sustained therapeutic effects in patients with moderate-to-severe psoriasis (1). The Lancet, March 2020, published two new studies (see below) describing the advancement of dermatology with the first anti-IL23 immunobiological drug approved for use in rheumatology (2, 3). In March 2018, guselkumab was the first IL-23p19 antagonist that was approved for plaque psoriasis treatment in Brazil (4). In psoriasis, pivotal phase III studies VOYAGE 1 and 2 (multicenter, randomized, double-blind, with adalimumab as an active comparator, and placebo) showed a significantly higher response rate in patients receiving guselkumab, with PASI75, PASI90, and PASI100 responses within 48 weeks, than in those receiving adalimumab and placebo (2). In the NAVIGATE study assessing the efficacy and safety of guselkumab in patients with …