33830 Prognostic factors for early PASI 100 response in psoriasis patients treated with guselkumab: Results from the GUIDE study

Abstract

Background: The ongoing phase IIIb, randomized, double-blind GUIDE study assesses the impact of early IL-23 blockade with guselkumab on the course of moderate–severe plaque-type psoriasis (PSO). Methods: 880 patients enrolled to receive 100 mg guselkumab at W0, 4, 12 and 20; patients maintaining complete skin clearance (PASI = 0) from W20–W28 are termed super-responders (SRs). A multivariate logistic regression analysis investigated the relationship between potential baseline prognostic/risk factors (age, gender, BMI, PASI, PSO duration, prior biologics) and the likelihood of being an SR. Results: Overall, 34.4% patients were SRs. At baseline, SRs were younger than non-SRs (mean age 39.4 vs 44.2 years), less likely to have BMI >25 kg/m2 (60.4% vs 72.6%), or have received biologics (6.9% vs 17.7%). Logistic regression did not show multicollinearity of the variables assessed and the model was significant overall (likelihood ratio P < .0001). PSO duration ≤2 years had a significant positive impact on the likelihood of being an SR (OR = 1.58; 95% CI:1.16–2.14; P = .0034), whereas prior biologics (0.47:0.28–0.78; P = .0039), each year of age (0.98:0.97–0.99; P = .0006) and each kg/m2 increase in BMI (0.95:0.93–0.98; P = .0002) decreased the odds of being an SR. Baseline PASI and gender had no significant influence. Conclusions: Complete skin clearance between W20–W28 following guselkumab treatment is significantly associated with a short disease duration (≤2 years) and is negatively impacted by prior biologics, and increasing BMI/age. As complete clearance is more likely to be achieved early in the disease course, early initiation of effective treatment may improve long-term control of PSO.