Why carry out this study?
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Guselkumab is an anti-interleukin-23 biologic approved by the US Food and Drug Administration (FDA) for the treatment of adult patients with moderate-to-severe plaque psoriasis or active psoriatic arthritis (PsA); however, characteristics of patients who initiate guselkumab in a real-world setting are not well described. |
The objective of this study was to describe baseline demographics, disease characteristics, and patient-reported outcome measures (PROMs) among patients with plaque psoriasis—including a subset of patients with concomitant dermatologist-diagnosed PsA—who initiated guselkumab in CorEvitas’ Psoriasis Registry. |
What was learned from the study?
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After patients with psoriasis were stratified according to the number of previously received biologics for comparison, biologic-naïve patients and those with the greatest previous exposure to biologics (4+ prior biologics) had the most severe disease and the worst PROM scores at baseline. |
Among patients with psoriasis and concomitant dermatologist-diagnosed PsA, biologic-naïve patients had more severe disease and worse PROM scores than biologic-experienced patients. |
This study is among the first to describe characteristics of patients with psoriasis with or without concomitant PsA initiating treatment with guselkumab in the real world, and the findings show important differences in baseline demographics, disease characteristics, and PROMs according to previous experience with biologic therapy. |
Introduction
Methods
Patient Population
Measures
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Demographics (age, gender, race, health insurance type, education, work status, smoking history, body weight, and body mass index [BMI])
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Disease characteristics (comorbidities [reported by the physician and based on CorEvitas questionnaires], psoriasis morphology and duration, diagnosis of PsA, Psoriasis Epidemiology Screening Tool [PEST] score; body surface area [BSA] affected [0–100%], Investigator Global Assessment [IGA; 0–4], and Psoriasis Area and Severity Index [PASI; 0–72])
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Treatment characteristics (concomitant therapy use, psoriasis treatment history, and reasons for initiating guselkumab)
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PROMs (patient-reported itch, fatigue, and skin pain due to psoriasis; patient-reported joint pain and wellness as a result of PsA among patients with dermatologist-diagnosed PsA; Patient Global Assessment [PGA] of psoriasis; Work Productivity and Activity Impairment [WPAI] questionnaire; Dermatology Life Quality Index [DLQI] questionnaire; and EuroQoL-5 dimensions, 3 levels [EQ-5D-3L] visual analog scale [VAS] health state and categorical domains)
Statistical Analysis
Results
Demographics and Disease Characteristics
Characteristicsa | Patients initiating guselkumab (N = 687) |
---|---|
Age (years), mean (SD) | 50.1 (14.3) |
Female, n (%) | 329 (48.0) |
White, n (%) | 558 (81.2) |
Private health insurance, n (%) | 558 (81.2) |
Some college or more, n (%) | 513 (74.9) |
Employed full time, n (%) | 428 (62.4) |
Current smoker, n (%) | 120 (17.7) |
Body weight (kg), mean (SD) | 94.9 (25.5) |
BMI > 30 kg/m2, n (%) | 379 (55.3) |
History of comorbidities, n (%) | |
Cancerb | 44 (6.4) |
Serious infections | 25 (3.6) |
Cardiovascular diseasec | 29 (4.2) |
Hypertension | 145 (21.1) |
Hyperlipidemia | 94 (13.7) |
Diabetes mellitus | 43 (6.3) |
Crohn’s disease | 5 (0.7) |
Ulcerative colitis | 4 (0.6) |
Depression | 69 (10.0) |
Anxiety | 76 (11.1) |
BSA (%), mean (SD) | 12.6 (14.2) |
PASI (score 0–72), mean (SD) | 8.0 (7.5) |
IGA, mean (SD) | 2.8 (0.9) |
Psoriasis morphology | |
Scalp | 267 (38.9) |
Nail | 119 (17.3) |
Palmoplantar | 93 (13.5) |
Genital | 49 (7.1) |
Psoriasis duration (years), mean (SD) | 16.8 (13.3) |
PsA, n/N1 (%) | 251/678 (37.0) |
Confirmed by rheumatologist, n/N1 (%) | 113/216 (52.3) |
PsA duration (years), mean (SD) (n = 226) | 9.3 (9.1) |
PEST score ≥ 3, n/N1 (%) | 202/679 (29.7) |
Initiated guselkumab because of active disease, n/N1 (%) | 115/130 (88.5) |
Concomitant therapy, n (%) | |
Systemic therapyd | 106 (15.4) |
Topical agents | 276 (40.2) |
Biologic-experienced patientse, n (%) | 560 (81.5) |
1 previous biologic agent received, n (%) | 171 (30.5) |
≥ 2 previous biologic agents received, n (%) | 389 (69.5) |
Characteristicsa | Number of prior biologicsb (n) | P valuec | ||||
---|---|---|---|---|---|---|
0 (n = 127) | 1 (n = 171) | 2 (n = 150) | 3 (n = 110) | 4+ (n = 129) | ||
Age (years), mean (SD) | 48.9 (15.9) | 49.7 (15.2) | 50.5 (12.6) | 51.1 (13.4) | 50.7 (14.1) | 0.14 |
Female, n (%) | 61 (48.0) | 93 (54.4) | 62 (41.3) | 51 (46.8) | 62 (48.1) | 0.24 |
White, n (%) | 105 (82.7) | 136 (79.5) | 116 (77.3) | 91 (82.7) | 110 (85.3) | 0.47 |
Private health insurance, n (%) | 106 (83.5) | 139 (81.3) | 121 (80.7) | 88 (80.0) | 104 (80.6) | 0.96 |
Some college or more, n (%) | 95 (75.4) | 128 (74.9) | 112 (74.7) | 87 (79.8) | 91 (70.5) | 0.61 |
Employed full time n, (%) | 82 (64.6) | 100 (58.5) | 98 (65.3) | 69 (63.3) | 79 (61.2) | 0.73 |
Current smoker, n (%) | 17 (13.7) | 25 (14.7) | 33 (22.3) | 16 (14.8) | 29 (22.8) | 0.11 |
Body weight (kg), mean (SD) | 88.3 (22.7) | 91.6 (24.9) | 96.0 (27.3) | 97.8 (23.6) | 102.1 (26.5) | < 0.001 |
BMI > 30 kg/m2, n (%) | 51 (40.5) | 85 (50.0) | 83 (55.3) | 73 (66.4) | 87 (67.4) | < 0.001 |
History of comorbidities, n (%) | ||||||
Cancerd | 6 (4.7) | 12 (7.0) | 12 (8.0) | 8 (7.3) | 6 (4.7) | 0.71 |
Serious infections^ | 0 (0.0) | 8 (4.7) | 8 (5.3) | 2 (1.8) | 7 (5.4) | 0.03 |
Cardiovascular diseasee | 7 (5.5) | 5 (2.9) | 7 (4.7) | 5 (4.5) | 5 (3.9) | 0.85 |
Hypertension | 36 (28.3) | 36 (21.1) | 30 (20.0) | 17 (15.5) | 26 (20.2) | 0.18 |
Hyperlipidemia | 22 (17.3) | 23 (13.5) | 19 (12.7) | 16 (14.5) | 14 (10.9) | 0.64 |
Diabetes mellitus^ | 10 (7.9) | 8 (4.7) | 13 (8.7) | 4 (3.6) | 8 (6.2) | 0.40 |
Crohn’s disease^ | 0 (0.0) | 1 (0.6) | 2 (1.3) | 2 (1.8) | 0 (0.0) | 0.34 |
Ulcerative colitis^ | 0 (0.0) | 0 (0.0) | 2 (1.3) | 1 (0.9) | 1 (0.8) | 0.46 |
Depression | 24 (18.9) | 19 (11.1) | 8 (5.3) | 7 (6.4) | 11 (8.5) | 0.002 |
Anxiety | 23 (18.1) | 22 (12.9) | 11 (7.3) | 9 (8.2) | 11 (8.5) | 0.03 |
BSA (%), mean (SD) | 15.0 (13.6) | 10.3 (12.1) | 12.8 (14.4) | 10.8 (15.2) | 14.6 (15.8) | < 0.001 |
PASI (score 0–72), mean (SD) | 8.9 (7.4) | 6.8 (7.1) | 7.6 (6.2) | 7.3 (6.8) | 9.6 (9.5) | 0.003 |
IGA, mean (SD) | 2.9 (0.8) | 2.6 (0.9) | 2.7 (0.9) | 2.7 (0.9) | 3.0 (0.8) | 0.004 |
Psoriasis morphology | ||||||
Scalp | 52 (40.9) | 57 (33.3) | 54 (36.0) | 43 (39.1) | 61 (47.3) | 0.15 |
Nail | 16 (12.6) | 20 (11.7) | 29 (19.3) | 22 (20.0) | 32 (24.8) | 0.02 |
Palmoplantar | 14 (11.0) | 16 (9.4) | 18 (12.0) | 15 (13.6) | 30 (23.3) | 0.007 |
Genital | 19 (15.0) | 11 (6.4) | 6 (4.0) | 5 (4.5) | 8 (6.2) | 0.004 |
Psoriasis duration (years), mean (SD) | 10.8 (11.6) | 16.6 (14.6) | 17.8 (13.3) | 19.7 (12.0) | 19.2 (12.4) | < 0.001 |
PsA, n/N1 (%) | 17/126 (13.5) | 49/168 (29.2) | 60/150 (40.0) | 56/109 (51.4) | 69/125 (55.2) | < 0.001 |
Confirmed by rheumatologist, n/N1 (%) | 10/16 (62.5) | 18/38 (47.4) | 24/53 (45.3) | 24/47 (51.1) | 37/62 (59.7) | 0.48 |
PsA duration (years), mean (SD) | n = 16 10.5 (15.4) | n = 45 6.2 (8.4) | n = 55 8.0 (8.3) | n = 53 11.6 (9.1) | n = 57 10.7 (7.3) | < 0.001 |
PEST score ≥ 3, n/N1 (%) | 24/126 (19.0) | 36/170 (21.2) | 49/146 (33.6) | 36/110 (32.7) | 57/127 (44.9) | < 0.001 |
Concomitant therapy, n (%) | ||||||
Systemic therapyf | 10 (7.9) | 20 (11.7) | 26 (17.3) | 24 (21.8) | 26 (20.2) | 0.009 |
Topical agents | 66 (52.0) | 61 (35.7) | 60 (40.0) | 46 (41.8) | 43 (33.3) | 0.02 |
Patient-Reported Outcome Measures
Characteristicsa | Number of prior biologicsb (n) | P valuec | ||||
---|---|---|---|---|---|---|
0 (n = 127) | 1 (n = 171) | 2 (n = 150) | 3 (n = 110) | 4+ (n = 129) | ||
Overall patient-reported outcomes, mean (SD) | ||||||
Overall itch/pruritus (VAS 0–100) | 59.3 (31.4) | 45.5 (34.3) | 47.7 (34.2) | 48.3 (33.9) | 59.0 (32.0) | < 0.001 |
Overall fatigue (VAS 0–100) | 34.5 (27.4) | 31.6 (27.5) | 32.8 (28.3) | 37.1 (32.5) | 45.6 (31.1) | < 0.001 |
Overall skin pain (VAS 0–100) | 33.7 (32.6) | 28.0 (30.6) | 31.5 (31.1) | 33.2 (35.8) | 40.7 (33.4) | 0.004 |
PGA (VAS 0–100) | 52.4 (28.2) | 41.7 (29.4) | 44.2 (29.2) | 43.2 (27.6) | 52.5 (28.9) | 0.001 |
WPAI, mean (SD) | ||||||
Currently employed, n (%) | 92 (72.4) | 111 (65.3) | 110 (73.8) | 74 (67.3) | 85 (65.9) | 0.39 |
% of work hours missed due to PsO | n = 81 5.1 (17.8) | n = 95 3.2 (12.4) | n = 94 4.2 (16.6) | n = 66 1.5 (5.1) | n = 82 6.1 (17.8) | 0.16 |
% of impairment while working due to PsO | n = 79 23.1 (25.4) | n = 96 14.8 (22.8) | n = 95 413.1 (22.2) | n = 66 10.8 (18.6) | n = 80 16.9 (23.0) | < 0.001 |
% of work hours affected by PsO | n = 79 24.3 (26.5) | n = 94 16.4 (24.1) | n = 92 13.9 (23.9) | n = 66 11.6 (19.6) | n = 80 19.1 (24.8) | < 0.001 |
% of daily activities impaired by PsO | n = 125 28.8 (29.3) | n = 168 19.0 (25.8) | n = 150 17.4 (24.0) | n = 108 21.3 (27.6) | n = 124 26.5 (29.8) | < 0.001 |
DLQI (score 0–30), mean (SD) | 9.4 (5.5) | 7.3 (6.0) | 6.5 (5.6) | 7.5 (6.1) | 9.2 (6.7) | < 0.001 |
DLQI “effect on life”, n (%) | 0.001 | |||||
0–1: none | 7 (5.6) | 32 (18.7) | 30 (20.1) | 16 (14.7) | 10 (7.8) | |
2–5: small | 28 (22.4) | 52 (30.4) | 48 (32.2) | 34 (31.2) | 36 (28.1) | |
6–10: moderate | 41 (32.8) | 38 (22.2) | 40 (26.8) | 28 (25.7) | 36 (28.1) | |
11–20: very large | 46 (36.8) | 43 (25.1) | 28 (18.8) | 26 (23.9) | 36 (28.1) | |
21–30: extremely large | 3 (2.4) | 6 (3.5) | 3 (2.0) | 5 (4.6) | 10 (7.8) | |
EQ-5D VAS (0–100), mean (SD) | 72.6 (21.5) | 75.8 (18.1) | 73.7 (18.3) | 70.4 (19.9) | 65.0 (24.2) | < 0.001 |
ED-5D-3L categorical domains, n (%)d | ||||||
Walking | 16 (13.1) | 38 (22.5) | 34 (22.8) | 35 (32.7) | 52 (40.9) | < 0.001 |
Self-care | 4 (3.3) | 10 (5.9) | 12 (8.1) | 9 (8.5) | 22 (17.5) | < 0.001 |
Usual activities | 39 (31.2) | 41 (24.0) | 35 (23.5) | 34 (31.8) | 51 (40.2) | 0.01 |
Pain and discomfort | 61 (49.6) | 79 (46.5) | 77 (51.7) | 59 (55.7) | 80 (64.0) | 0.04 |
Anxiety and depression | 33 (27.3) | 51 (30.2) | 39 (26.4) | 36 (34.0) | 48 (38.1) | 0.22 |
Problems with sleeping | 21 (16.7) | 25 (14.7) | 29 (19.5) | 17 (15.6) | 22 (17.1) | 0.84 |
Baseline Characteristics and Patient-Reported Outcome Measures Among Patients with Psoriasis and Concomitant Psoriatic Arthritis
Characteristicsa | Prior biologic useb (n) | Standardized differencec | |
---|---|---|---|
Biologic-naïve (n = 17) | Biologic-experienced (n = 234) | ||
Age (years), mean (SD) | 53.8 (10.9) | 52.9 (13.0) | 0.07 |
Female, n (%) | 10 (58.8) | 127 (54.3) | 0.09 |
White, n (%) | 13 (76.5) | 190 (81.2) | 0.11 |
Private health insurance, n (%) | 16 (94.1) | 185 (79.1) | 0.45 |
Some college or more, n (%) | 12 (70.6) | 165 (70.5) | 0.00 |
Employed full time n, (%) | 11 (64.7) | 135 (57.7) | 0.14 |
Current smoker, n (%) | 4 (25.0) | 45 (19.2) | 0.14 |
Body weight (kg), mean (SD) | 93.5 (23.5) | 98.6 (27.2) | 0.20 |
BMI > 30 kg/m2, n (%) | 9 (52.9) | 150 (64.1) | 0.22 |
History of comorbidities, n (%) | |||
Cancerd | 0 (0.0) | 12 (5.1) | 0.33 |
Serious infections | 0 (0.0) | 15 (6.4) | 0.37 |
Cardiovascular diseasee | 2 (11.8) | 12 (5.1) | 0.24 |
Hypertension | 7 (41.2) | 51 (21.8) | 0.43 |
Hyperlipidemia | 1 (5.9) | 26 (11.1) | 0.19 |
Diabetes mellitus | 3 (17.6) | 14 (6.0) | 0.37 |
Crohn’s disease | 0 (0.0) | 2 (0.9) | 0.13 |
Ulcerative colitis | 0 (0.0) | 2 (0.9) | 0.13 |
Depression | 2 (11.8) | 22 (9.4) | 0.08 |
Anxiety | 2 (11.8) | 23 (9.8) | 0.06 |
BSA (%), mean (SD) | 15.1 (13.7) | 11.9 (14.2) | 0.23 |
PASI (score 0–72), mean (SD) | 10.9 (7.5) | 8.0 (8.1) | 0.38 |
IGA, mean (SD) | 3.3 (0.7) | 2.8 (0.9) | 0.58 |
Psoriasis morphology | |||
Scalp | 10 (58.8) | 95 (40.6) | 0.37 |
Nail | 3 (17.6) | 56 (23.9) | 0.16 |
Palmoplantar | 2 (11.8) | 49 (20.9) | 0.25 |
Genital | 6 (35.3) | 15 (6.4) | 0.76 |
Psoriasis duration (years), mean (SD) | 20.6 (15.7) | 17.8 (13.1) | 0.19 |
PsA, n (%) | 17 (100) | 234 (100) | – |
Confirmed by rheumatologist, n/N1 (%) | 10/16 (62.5) | 103/200 (51.5) | 0.22 |
PsA duration (years), mean (SD) | n = 16 10.5 (15.4) | n = 210 9.3 (8.5) | 0.10 |
PEST score ≥ 3, n/N1 (%) | 9/17 (52.9) | 130/230 (56.5) | 0.07 |
Concomitant therapy, n (%) | |||
Systemic therapyf | 1 (5.9) | 49 (20.9) | 0.45 |
Topical agents | 11 (64.7) | 84 (35.9) | 0.60 |
Characteristicsa | Prior biologic useb (n) | Standardized differencec | |
---|---|---|---|
Biologic-naïve (n = 17) | Biologic-experienced (n = 234) | ||
Overall patient-reported outcomes, mean (SD) | |||
Overall itch/pruritus (VAS 0–100) | 76.9 (21.5) | 54.1 (33.5) | 0.81 |
Overall fatigue (VAS 0–100) | 50.6 (27.9) | 44.8 (31.1) | 0.20 |
Overall skin pain (VAS 0–100) | 53.7 (30.9) | 40.8 (33.4) | 0.40 |
PGA (VAS 0–100) | 66.6 (18.9) | 50.3 (27.7) | 0.69 |
PsA patient-reported outcomes, n | 16 | 206 | |
Joint pain due to PsA (VAS 0–100), mean (SD) | 49.9 (28.5) | 45.6 (32.1) | 0.14 |
Wellness as a result of PsA (VAS 0–100), mean (SD) | 52.6 (28.8) | 43.2 (30.2) | 0.32 |
WPAI, mean (SD) | |||
Currently employed, n (%) | 12 (70.6) | 150 (64.1) | 0.14 |
% of work hours missed due to PsO | n = 10 4.3 (11.7) | n = 132 5.8 (17.8) | 0.10 |
% of impairment while working due to PsO | n = 10 35.5 (28.9) | n = 130 16.8 (24.1) | 0.70 |
% of work hours affected by PsO | n = 10 37.8 (30.3) | n = 129 18.3 (26.1) | 0.69 |
% of daily activities impaired by PsO | n = 16 40.9 (26.9) | n = 229 29.1 (30.0) | 0.41 |
DLQI (score 0–30), mean (SD) | 11.4 (4.8) | 8.6 (6.5) | 0.49 |
DLQI “effect on life”, n (%) | 0.73 | ||
0–1: none | 0 (0.0) | 29 (12.6) | |
2–5: small | 2 (11.8) | 61 (26.4) | |
6–10: moderate | 6 (35.3) | 58 (25.1) | |
11–20: very large | 8 (47.1) | 69 (29.9) | |
21–30: extremely large | 1 (5.9) | 14 (6.1) | |
EQ-5D VAS (0–100), mean (SD) | 62.2 (17.8) | 67.3 (21.4) | 0.26 |
ED-5D-3L categorical domains, n (%)d | |||
Walking | 7 (43.8) | 97 (42.2) | 0.03 |
Self-care | 1 (6.3) | 36 (15.8) | 0.31 |
Usual activities | 11 (68.8) | 96 (41.7) | 0.56 |
Pain and discomfort | 13 (81.3) | 169 (73.5) | 0.19 |
Anxiety and depression | 4 (25.0) | 95 (41.3) | 0.35 |
Problems with sleeping | 3 (17.6) | 50 (21.6) | 0.10 |