Long-Term Effectiveness of Guselkumab vs. Other Biologic Therapies Among Plaque Psoriasis Patients in the CorEvitas Psoriasis Registry

Introduction: The efficacy and real-world treatment persistence of guselkumab (GUS) has been shown to be superior to other advanced treatment options [1,2] for psoriasis (PsO); however, long-term real-world effectiveness vs. other biologic therapies warrants further study. Therefore, this study compared the real-world effectiveness of GUS with adalimumab (ADA), ixekizumab (IXE), secukinumab (SEC), and ustekinumab (UST) in PsO patients through 30 months of follow-up. Methods: An active comparator, new-user design was used to compare initiators of GUS to each comparator separately among adult patients with plaque PsO, an Investigator’s Global Assessment (IGA) score ≥2, and at least 30 months of follow-up prior to the data cutoff (June 2024) enrolled in the CorEvitas Psoriasis Registry in the US and Canada. Stabilized standardized mortality ratio (SMR) weights were used to balance baseline characteristics between GUS and each comparator. The primary outcome was achievement of IGA 0/1 at 30 months. Dermatology Life Quality Index (DLQI) 0/1 was assessed as a secondary outcome. Absolute differences were reported after incorporating the SMR weights. For all comparisons, P<0.05 was considered statistically significant and Bonferroni-Holm adjustments were made for multiple testing. Results: After balancing on baseline characteristics, significantly greater proportions of GUS initiators achieved IGA 0/1 vs. those in each comparator group (GUS 50.7% (n=428) vs. ADA 24.0% (n=309): difference=26.7%, 95% CI: 13.6-39.7; p<0.001; GUS 43.4% (n=587) vs. IXE 33.6% (n=580): difference=9.9%, 95% CI: 2.6-17.1; p=0.005; GUS 45.8% (n=546) vs. SEC 29.9% (n=614): difference=15.9%, 95% CI: 6.8-25.0; p<0.001; GUS 45.9% (n=466) vs. UST 36.2% (n=224): difference=9.7%, 95% CI: 0.6-18.7; p=0.036). Similarly, greater proportions of GUS initiators achieved DLQI 0/1 vs. the comparators. Conclusion: Our findings suggest that GUS was superior to ADA, IXE, SEC, and UST in achieving both IGA 0/1 and DLQI 0/1 at 30 months. This is among the largest and longest real-world comparative effectiveness studies of GUS vs. ADA, IXE, SEC, and UST in PsO patients. Additional studies with longer follow-up and inclusion of emerging therapies could provide further data to inform clinical treatment considerations.