ECLIPSE highlights benefit of guselkumab over secukinumab for moderate-to-severe plaque psoriasis
Individuals with moderate-to-severe plaque psoriasis may reap better long-term improvements in the severity of their condition when treated with guselkumab over secukinumab, according to findings of the phase III ECLIPSE* trial presented at the recent Inflammatory Skin Disease Summit (ISDS 2018) held in Vienna, Austria.
This multicentre, double-blind trial involved 1,048 adult patients with moderate-to-severe plaque psoriasis who were randomized to receive a single subcutaneous injection of guselkumab (100 mg at weeks 0, 4, and 12 followed by every 8 weeks; n=534) or secukinumab (two subcutaneous injections of 150 mg each for a total of 300 mg at weeks 0, 1, 2, 3, and 4 followed by every 4 weeks; n=514) for 44 weeks.
At week 48, more patients who received guselkumab than secukinumab achieved a PASI90** response (84.5 percent vs 70.0 percent; p<0.001). [ISDS 2018, abstract LB 4]
Guselkumab also led to more patients achieving a PASI75 response at both weeks 12 and 48 than those on secukinumab (84.6 percent vs 80.2 percent; p<0.001 for noninferiority and p=0.062 for superiority).
At week 12, guselkumab did not did not appear to demonstrate noninferiority or superiority over secukinumab in terms of PASI90 response (69.1 percent vs 76.1 percent; p=0.127 for noninferiority), while more patients achieved PASI75 with secukinumab over guselkumab (91.6 percent vs 89.3 percent; p<0.001 for noninferiority).
However, guselkumab demonstrated superiority over secukinumab with regard to PASI100 response (58.2 percent vs 48.4 percent; p=0.001), IGA*** score 0 (clear; 62.2 percent vs 50.4 percent; p<0.001), and IGA score 0/1 (clear or minimal; 85.0 percent vs 74.9 percent; p<0.001) at week 48.
The adverse event (AE) profile was comparable between guselkumab and secukinumab recipients with 77.9 and 81.6 percent of patients, respectively, reporting at least one AE, and 6.2 and 7.2 percent, respectively, reporting serious AEs. Six patients who received guselkumab experienced serious infections compared with five who received secukinumab.
“The response-over-time curves show that maximum response rates with guselkumab are achieved after 6 months and are maintained over time through 1 year, achieving superiority at the primary endpoint of the study,” said study lead investigator Professor Richard Langley from the Division of Clinical Dermatology and Cutaneous Science, Department of Medicine, Dalhousie University, in Halifax, Nova Scotia, Canada.
“Results of the study confirm a slightly more rapid onset of response with secukinumab, but importantly in a chronic disease like psoriasis, these data provide new insights into comparative longer-term efficacy,” he added.