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Internal Medicine • Rheumatology • Spondyloarthritis • Psoriatic arthritis • ACR Journal Club
How long would you recommend that a patient continues guselkumab prior to deciding that the therapy is not effective?
In contrast to TNF inhibitors for psoriatic arthritis, which seem to peak and maintain response percentages, the DISCOVER-2 Trial (McInnes et al., PMID 34719872) suggests Il-23 inhibitors have a steady increase in response up to 2 years which makes it challenging to assess when a patient is failing therapy versus not yet responding. Is there a biologic explanation as to why Il-23 inhibitors may continue to have this gradual increase in response up to 2 years?
Answer from: at Community Practice
Many trials have a placebo-controlled period of 12-24 weeks. Thereafter, all patients receive active treatment. Even if the original treatment allocation remains unknown to the patient and doctor, they know that from that moment on, everyone receives active treatment. This will have an influence on ...
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Answer from: at Academic Institution
I recommend at least a 6 month trial of Guselkumab prior to switching to a different therapy. However, the decision to switch has to be made considering many variables including the degree of response or lack thereof, insurance coverage, and a shared decision-making process with the patient involvem...
Answer from: at Community Practice
I encourage patients to remain on the drug for at least 6 months since we have observed improving responses out to as long as 2 years. One theoretical reason for this continued increasing response may have to do with IL-23 inhibition working “upstream” in the cascade of its impact, for e...
Answer from: at Community Practice
Most of my patients who meet criteria for treatment with this drug have persistent and active disease despite other therapies. While I try to encourage them to stay with the drug for 6 MOs, many want to move on to try other drugs when there is no or minimal response.