Safety in moderate-to-severe plaque psoriasis patients with latent tuberculosis treated with guselkumab and anti-tuberculosis treatments concomitantly: results from pooled phase 3 VOYAGE 1 & VOYAGE 2 trials
Journal
Journal of the European Academy of Dermatology and Venereology
Journal Volume
34
Journal Issue
8
Pages
1744-1749
Date Issued
2020
Author(s)
Abstract
Background: Patients treated with tumour necrosis factor (TNF) inhibitors are at risk of new-onset tuberculosis (TB) or reactivation of latent tuberculosis infection (LTBI). Association between TB/LTBI and interleukin (IL)-23 inhibitors for psoriasis is unclear. Patients with LTBI typically initiate LTBI therapy before receiving biologics. Objectives: Safety in moderate-to-severe psoriasis patients with LTBI treated with guselkumab (IL-23 inhibitor) and LTBI treatment was evaluated. Methods: In the VOYAGE 1 & VOYAGE 2 studies, patients screened for LTBI were randomized to guselkumab, placebo, or adalimumab (TNF inhibitor) at baseline. Placebo?→?guselkumab crossover occurred at week 16 and adalimumab?→?guselkumab at week 52 (VOYAGE 1), or at week 28 or later (VOYAGE 2). Incidence of active TB, adverse events (AEs), serious AEs (SAEs), and markedly abnormal liver function tests [alanine aminotransferase test (ALT); aspartate aminotransferase test (AST)] were evaluated using pooled data through week 100 in guselkumab-treated patients receiving and not receiving LTBI treatment. Results: At baseline, 130 randomized patients (guselkumab: n?=?69; adalimumab: n?=?36; placebo: n?=?25) tested positive for LTBI and received concomitant LTBI treatments (LTBI+). No active TB was reported among guselkumab-treated patients without LTBI (LTBI?) through week 100. Two cases of active TB occurred in LTBI? patients treated with adalimumab. Through week 16, across all treatment groups, greater proportions of LTBI+ patients reported ALT and AST elevations compared with LTBI? patients. Through week 100, proportions of patients experiencing AEs and SAEs were comparable between LTBI+ and LTBI? patients. Conclusions: No cases of active TB, including reactivation of LTBI, were reported in patients with or without LTBI treated with guselkumab through up to 2?years. LTBI treatment was effective across all treatment groups in preventing reactivation of LTBI. Long-term treatment with guselkumab was generally well-tolerated through up to 2?years in patients receiving LTBI medications. ? 2020 European Academy of Dermatology and Venereology
SDGs
Other Subjects
adalimumab; alanine aminotransferase; aspartate aminotransferase; ethambutol; guselkumab; isoniazid; isoniazid plus rifampicin; nicotinamide; placebo; pyrazinamide; rifabutin; rifampicin; tuberculostatic agent; guselkumab; monoclonal antibody; tuberculostatic agent; Article; controlled study; demography; drug safety; drug tolerability; follow up; human; hypertransaminasemia; latent tuberculosis; liver function test; major clinical study; priority journal; psoriasis vulgaris; side effect; study design; treatment duration; double blind procedure; psoriasis; randomized controlled trial; severity of illness index; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antitubercular Agents; Double-Blind Method; Humans; Latent Tuberculosis; Psoriasis; Severity of Illness Index
Publisher
Blackwell Publishing Ltd
Type
journal article