Guselkumab Improves Symptoms, Stigmatization with Long-Term Use for Psoriasis

Long-term guselkumab use may improve skin symptoms, sexual impairment issues, and feelings of stigmatization in those with psoriasis, new data suggest.¹

These findings from the G-EPOSS study were recently published in the Journal of Dermatology and authored by such investigators as Sascha Gerdes, MD, of the Department of Dermatology at the University Medical Center Schleswig-Holstein, Campus Kiel in Germany. Gerdes and colleagues highlighted that issues related to sexual impairment can be experienced by more than half of all patients with psoriasis, especially those with anogenital psoriasis.²

Additionally, the investigative team noted that perceived stigmatization is often experienced by an even greater number of patients, in turn exacerbating mental health issues and decreasing well-being.³

“The G-EPOSS study aims to evaluate the long-term effectiveness of guselkumab for improving psoriasis, HRQoL, sexual impairment, and perceived stigmatization outcomes in patients with moderate-to-severe plaque psoriasis in routine clinical practice,” Gerdes and coauthors wrote.^1,4 “Primary endpoint findings were previously published; here, we present key secondary endpoints from the final week (W)76 data cut, reporting outcomes across diverse patient subgroups.”

G-EPOSS Trial Design

The investigative team highlighted the design of G-EPOSS, noting that the study was an observational, prospective, multi-center investigation carried out in Germany. The team focused their attention on adult patients living with with moderate-to-severe plaque psoriasis. Those deemed eligible to participate in G-EPOSS had a confirmed diagnosis of moderate-to-severe plaque psoriasis with a baseline Psoriasis Area and Severity Index (PASI) score above 3, were at least 18 years of age, and were considered appropriate candidates for systemic medications.

The implementation among these patients of non-biologic concomitant psoriasis drugs was permitted by Gerdes et al in accordance with routine clinical practice. The investigators’ patient recruitment period took place between October 2019 – August 2021 across 44 study sites. Those involved as participants were then treated with guselkumab 100 mg at the point of baseline, the 4-week mark, and subsequently every 8 weeks until the 76-week mark. This was noted as consistent with local clinical practice and guidelines for prescribing.

Gerdes and coauthors’ primary endpoint was determined to be attainment of PASI ≤3 at Week 28, and such results were reported previously.⁴ Over the course of the full 76-week treatment period, the investigative team looked at such secondary endpoints as Dermatology Life Quality Index (DLQI), Nail Psoriasis Severity Index (NAPSI) scores, anogenital Physician’s Global Assessment (aPGA), Relationship and Sexuality Scale (RSS), Patient Benefit Index (PBI), the results of the Perceived Stigmatization Questionnaire (PSQ), and rates of drug survival.

The team conducted their analyses among those in the overall cohort and in subgroups. These subgroups were defined by patients’ ages, body mass index (BMI), duration of disease, presence of anogenital psoriasis, sex, depression, and attainment of “super-responder” status. The latter group’s status was defined as PASI = 0 at both the 20 and 28-week marks.

Guselkumab Effects on Psoriasis

There were 295 patients included in the final analysis. Gerges and colleagues highlighted that at baseline, trial subjects’ mean disease duration had been 17.4 years and their mean PASI and aPGA scores were 15.3 and 2.7, respectively. In terms of prior biologic exposure, it had been observed among 26.4% of the G-EPOSS participants. At the 76-week mark, the team found that 87.5% of subjects reported PASI ≤3, and 47.3% achieved complete clearance (PASI = 0).¹

The investigators noted a substantial increase in response rates among trial participants showing a shorter duration of their disease. Overall, Gerdes et al found that 18.3% of the subjects met the aforementioned criteria for super-response. In those who entered the analysis with nail involvement (NAPSI ≥1) or anogenital disease (aPGA ≥1), complete clearance was seen in 52.2% (NAPSI = 0) and 75.8% (aPGA = 0) by the 76-week mark, respectively.

Complete clearance of psoriasis in the anogenital region (aPGA = 0) was found by the investigators to be consistently high across all of the BMI categories. The team also noted significant improvements across all of the patient-reported outcomes they had assessed (DLQI, RSS, PSQ), and these benefits extended across each of the subgroups. Those with shorter psoriasis duration tended to report having greater improvement in some measures. 88.1% of subjects at Week 76 showed a PBI of >3, and treatment persistence was estimated at 88.7%. Notably, Gerdes and coauthors found no new safety concerns were during G-EPOSS.

“The findings emphasize the importance of involving the patient’s view and considering sensitive topics not always openly communicated by patients,” the investigators concluded.¹ “In summary, a holistic view of patients and their treatments is important for optimal care; G-EPOSS supports findings that guselkumab not only addresses physical symptoms but also improves overall patient wellbeing.”

References

1. S Gerdes, P Weisenseel, D Groß, et al. “Long-Term Impact of Guselkumab on Skin, Sexuality, and Perceived Stigmatization in Patients With Psoriasis in Routine Clinical Practice: Week 76 Effectiveness and Safety Results From the Prospective German Multicenter G-EPOSS Study,” The Journal of Dermatology (2025): 1–14, https://doi.org/10.1111/1346-8138.17866.

2. JC Cather, C Ryan, K Meeuwis, et al. “Patients’ Perspectives on the Impact of Genital Psoriasis: A Qualitative Study,” Dermatology and Therapy 7 (2017): 447–461.

3. A Chen, KM Beck, E Tan, J Koo. “Stigmatization in Psoriasis,” Journal Psoriatic Arthritis 3 (2018): 100–106.

4. S Gerdes, R Ostendorf, A Suss, et al. “Effectiveness, Safety and Impact of Guselkumab on Sexuality and Perceived Stigmatization in Patients With Psoriasis in Routine Clinical Practice: Week 28 Results From the Prospective German Multicentre G-EPOSS Study,” Journal of the European Academy of Dermatology and Venereology 39 Suppl 1 (2024): 15–26.