Janssen’s TREMFYA delivers improvement in psoriatic arthritis joint and skin symptoms at week 52 in phase 3 trials

The Janssen Pharmaceutical Companies of Johnson & Johnson announced new data from two Phase 3 clinical trials, DISCOVER-1 and DISCOVER-2, which showed that TREMFYA (guselkumab) demonstrated improvements in multiple clinical outcomes including joint symptoms, skin symptoms, soft tissue inflammation, physical function and reduction in radiographic progression at week 52 in adult patients with active psoriatic arthritis (PsA).

Guselkumab is currently not licensed for the treatment of PsA and is undergoing evaluation for this use by the European Medicines Agency (EMA). Data from the two studies in the DISCOVER programme formed the basis of the validated filing on 11 October 2019 to the EMA in the European Union (EU) for approval of guselkumab for the treatment of adult patients with active PsA and primary endpoint results were recently published in The Lancet.

“Those who are living with active psoriatic arthritis are faced with debilitating symptoms and inflammation which may ultimately lead to irreversible damage to the joints,” said Christopher Ritchlin, M.D., M.P.H., Chief of the Division of Allergy, Immunology and Rheumatology and Director of the Clinical Immunology Research Center at the University of Rochester Medical Center in Rochester, New York and lead investigator of the DISCOVER-1 study. “Findings from the DISCOVER-1 and DISCOVER-2 studies are encouraging for patients and physicians alike who may be seeking new treatment options that utilise mechanisms of action different to anti-tumour necrosis factor (TNF) alpha biologics to combat the multi-faceted combination of symptoms presented by psoriatic arthritis.”

DISCOVER-1 and DISCOVER-2 evaluated the efficacy and safety of guselkumab compared to placebo. DISCOVER-1 included patients who were biologic-naïve or had previously been exposed to anti-TNF alpha biologics. DISCOVER-2 included patients who were biologic-naïve only; it also assessed radiographic progression of joint damage. In both studies, patients were randomised to guselkumab 100 mg every 4 weeks (q4w) or every 8 weeks (q8w) for one year, or to placebo with crossover to guselkumab q4w at week 24 through one year. These findings are being presented as poster tours (SAT0397/SAT0402) at this year’s European League Against Rheumatism (EULAR) E-Congress, at which Janssen is sharing data in a total of 32 abstracts.

In both studies, American College of Rheumatology (ACR) response rates at week 52 included non-responder imputation (NRI) data, which categorised patients who discontinued the study as non-responders from week 24 to 52.

In DISCOVER-1, data demonstrated that at week 52:

• 73 percent of guselkumab q4w patients and 60 percent of guselkumab q8w patients achieved ACR20; 54 percent of guselkumab q4w patients and 39 percent of guselkumab q8w patients achieved ACR50 (NRI).

• Among patients who had clinically relevant psoriasis at baseline, 83 percent of guselkumab q4w patients, 69 percent of guselkumab q8w patients and 82 percent of patients who crossed over from placebo to guselkumab q4w achieved clear or almost clear skin with at least a 2 grade improvement from baseline as measured by the Investigator Global Assessment (IGA) score (observed data).

In DISCOVER-2, data demonstrated that at week 52:

• 71 percent of guselkumab q4w patients and 75 percent of guselkumab q8w patients achieved ACR20; 46 percent of guselkumab q4w patients and 48 percent of guselkumab q8w patients achieved ACR50 (NRI).

• Among patients who had clinically relevant psoriasis at baseline, 84 percent of guselkumab q4w patients, 77 percent of guselkumab q8w patients and 84 percent of patients who crossed over from placebo to guselkumab q4w achieved clear or almost clear skin with at least a 2 grade improvement from baseline as measured by the IGA score (observed data).

• Guselkumab q4w and q8w demonstrated sustained improvements in inhibition of radiographic progression of joint structural damage through week 52 (observed data).

The DISCOVER studies also showed improvements in multiple secondary endpoints at week 52 compared with week 24,1,2 including ACR70 response, resolution of soft tissue inflammation (enthesitis and dactylitis)c,d, disease activity score (DAS-28) (C-Reactive Protein [CRP])e (minimal disease activity [MDA])f (very low disease activity [VLDA])g, improvement in physical function (Health Assessment Questionnaire Disability Index [HAQ-DI])h, general health outcomes (SF-36 Physical Component Summary [PCS] and Mental Component Summary [MCS]).

In both studies, guselkumab was well-tolerated through study completion, and observed adverse events (AEs) were generally consistent with previous studies of guselkumab and current prescribing information.6 Serious AEs and serious infections occurred in 4 percent and 1 percent of guselkumab-treated patients, respectively, in both DISCOVER-1 and DISCOVER-2. There were no reported deaths in guselkumab-treated patients and no guselkumab-treated patient had inflammatory bowel disease, opportunistic infections, active tuberculosis or anaphylactic or serum sickness-like reactions.

“Efficacy of guselkumab in psoriatic arthritis was previously demonstrated to be superior to placebo at week 24. These new data show that efficacy is maintained to week 52 with safety data that are consistent with the well-established profile of guselkumab in psoriasis,” said Alyssa Johnsen, M.D., Ph.D., Vice President, Rheumatology Disease Area Leader, Janssen Research & Development, LLC. “We are excited to share the data on guselkumab in psoriatic arthritis as we continue to advance our research in this disease and bring more treatment options to psoriatic arthritis patients in need.”

In a separate study, data from DISCOVER-1 and DISCOVER-2 were analysed as part of a network meta-analysis that compared the efficacy and safety of guselkumab to other targeted biologic therapies for PsA. Twenty-six Phase 3 studies were included comparing the impact of 13 targeted therapies for PsA on ACR 20/50/70 response, Psoriasis Area Severity Index (PASI) 75/90/100 response, HAQ-DI score, resolution of enthesitis, resolution of dactylitis, AEs and serious AEs. The analysis is being shared as an abstract (Abstract AB0820) during the EULAR E-Congress.