Guttate psoriasis can go into remission, allowing short term courses of phototherapy or methotrexate to be effective treatments. Guselkumab is more effective than methotrexate (guselkumab is more effective head-to-head compared to adalimumab, which is more effective than methotrexate)4-6 and the effects of guselkumab are long lived (with almost 40% of patients maintaining 90% improvement in Psoriasis Area and Severity Index for 6 months after just 4 doses of the medication). 5 Based on that, we expected that the patient with the flare of psoriasis plaques in a guttate pattern would respond well to the treatment.
Long-term studies of guselkumab will be important for determining its efficacy and safety. We suspect one-time dosing with a potent, long acting medication like guselkumab may be a very effective, safe, and convenient way to manage acute and extensive exacerbations of psoriasis.
- Wu JJ, Gudjonsson JE. “Psoriasis and Systemic Disease.” Dermatologic Signs of Systemic Disease, 5th ed., Elsevier, Inc., 2017, pp. 45–50.
- Owen CM, Chalmers R, O’Sullivan T, Griffiths CEM. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev. 2019;6:3.
- Wechter T, Cline A, Feldman SR. Targeting p19 as a treatment option for psoriasis: an evidence-based review of guselkumab. Ther Clin Risk Manag. 2018;14:1489-1497.
- Blauvelt A, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phase III, double-blinded, placebo- and active comparator–controlled VOYAGE 1 trial. J Am Acad Dermatol. 2017;76(3):405-417.
- Reich K, Armstrong AW, Foley P et al. Efficacy and safety of guselkumab compared with adalimumab for the treatment of moderate-to-severe psoriasis: results from the phase 3, double-blind, placebo- and active comparatorcontrolled VOYAGE 2 trial. J Am Acad Dermatol. 2017;76:418–431.
- Saurat, J.-H., et al. Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION).” Br J Dermatol. 2007;158:558–566.