Two-Year Treatment Persistence of Guselkumab vs Other Biologics in Plaque Psoriasis Patients

August 2025 | Volume 24 | Issue 8 | 762 | Copyright © August 2025


Published online July 17, 2025

Bruce E. Strober MD PhDa, Jud C. Janak PhDb, Timothy Fitzgerald PhD MAc, Maya Marchese MSb, Rachel E. Teneralli PhD MSd, Katelyn Rowland MS ARNPc, Olivia Choi MD PhDc, Daphne Chan PhDc, Elizabeth Lesser MSb, Michael Cameron MDe, Mark Lebwohl MDe

aYale University School of Medicine, New Haven, CT; Central Connecticut Dermatology, Cromwell, CT
bCorEvitas, LLC, Waltham, MA
cJanssen Scientific Affairs, Horsham, PA
dJanssen Global Services, LLC, Horsham, PA
eIcahn School of Medicine at Mount Sinai, New York, NY

Abstract
Objective: The study objective was to compare long-term treatment persistence between patients initiating guselkumab vs 3 commonly prescribed biologics in the United States.
Methods: Adult plaque psoriasis patients enrolled in the CorEvitas Psoriasis Registry initiating guselkumab, adalimumab, secukinumab, or ixekizumab (July 2017 - January 2022) were divided into biologic-naïve and biologic-experienced cohorts. The primary outcome measure was average 2-year treatment persistence, estimated as restricted mean survival time (RMST), comparing guselkumab with adalimumab, secukinumab, and ixekizumab. Standardized mortality ratio weighting was used to adjust for confounding.
Results: 1,007 biologic-naïve and 1,584 biologic-experienced treatment initiations were included. For biologic-naïve initiators, the weighted-average treatment persistence for guselkumab was 20.3 months (95% CI: 19.4, 21.3), 14.6 months (13.5, 15.7) for adalimumab; 17.5 months (16.5, 18.6) for secukinumab, and 18.9 months (17.8, 20.1) for ixekizumab. The RMST difference for guselkumab was 24.9 weeks (95% CI: 18.4, 31.3) vs adalimumab, 12.1 weeks (5.9, 18.2) vs secukinumab and 6.0 weeks (0.4, 12.4) vs ixekizumab. For biologic-experienced initiators, the weighted-average treatment persistence for guselkumab was 17.6 months (95% CI: 16.9, 18.4), 13.5 months (11.6, 15.5) for adalimumab, 16.5 months (15.7, 17.3) for secukinumab, and 16.9 months (16.1, 17.8) for ixekizumab. The RMST difference for guselkumab was 17.7 weeks (95% CI: 8.7, 26.7) vs adalimumab, 5.0 weeks (0.2, 9.1) vs secukinumab and 2.9 weeks (-1.9, 7.7) vs ixekizumab.
Conclusions: In both biologic-naïve and biologic-experienced cohorts in this real-world study, average treatment persistence was significantly longer for guselkumab compared to adalimumab and secukinumab and numerically longer compared to ixekizumab.

INTRODUCTION

Numerous biologic therapies have been approved to treat moderate-to-severe plaque psoriasis with the potential to control disease and reduce the long-term risk of adverse sequelae.1 However, the optimization of treatment outcomes to achieve long-term safety and durable effectiveness remains challenging.2 On July 13, 2017, guselkumab was the first interleukin-23 inhibitor (IL-23i) approved by the United States (US) Food and Drug Administration (FDA) to treat moderate-to-severe plaque psoriasis. Guselkumab has shown promise of sustained efficacy in pivotal clinical trials and in early follow-up from real-world effectiveness studies. Clinical trial data has demonstrated: 1) guselkumab is efficacious and safe through 5 years,3-5 2) guselkumab has superior efficacy compared to adalimumab and secukinumab,6 and 3) guselkumab has demonstrated efficacy in ustekinumab inadequate responders.7 However, evidence of long-term outcomes of guselkumab compared to other biologics in US real-world patients remains limited.

Treatment persistence may be influenced by clinical factors such as effectiveness and safety, patient preference, and non-clinical factors, including insurance and cost. Understanding long-term treatment persistence and relative persistence between different treatments can guide treatment strategies for providers and patients. The primary objective of this study was to compare the 2-year drug persistence of biologic-naïve and biologic-experienced patients initiating guselkumab to patients initiating three commonly prescribed biologics for the treatment of plaque psoriasis: adalimumab, secukinumab, and ixekizumab.