A trial to compare two treatments for psoriasis: Guselkumab and fumaric acid esters

Plaque psoriasis is a common skin disease characterized by skin scales and red patches. It affects about 2% of all people. A complete cure is not possible, but several drugs can improve symptoms. This study, from Germany, aimed to compare a new drug called “guselkumab” with “fumaric acid esters (FAE)” that are commonly used in Germany to treat psoriasis. Psoriasis patients received, by random allocation, either guselkumab or FAE, and after 24 weeks the researchers evaluated how well the drugs worked (efficacy) and how well they were tolerated (safety). The Psoriasis Area Severity Index (PASI) is used to record the redness, thickness and scaling of a patient's psoriasis and to measure how well a treatment works, as a reduction in the PASI score means a reduction in these symptoms. For example, if a patient achieves PASI 75, it means they had a 75% or more reduction in their PASI score from the start. In this study, at week 24, 82% of guselkumab patients and 14% of FAE patients improved their baseline PASI score by at least 90% (PASI 90 response). This means that more patients in the guselkumab group had great relief in symptoms than patients in the FAE group. Patients answered the “Dermatology Life Quality Index (DLQI)” questionnaire to measure the impact of their skin disease on different aspects of their quality of life, like symptoms and feelings, daily activities, leisure, personal relationships and side effects of treatment. After 24 weeks of treatment, more guselkumab patients (62%) reported that their psoriasis no longer bothered them at all (DLQI score of 0/1) than FAE patients (17%). Undesired harmful incidents or side effects, called adverse events, occurred less often in the guselkumab group. In conclusion, guselkumab was more effective as a treatment for plaque psoriasis and better tolerated than FAE after 24 weeks. Linked Article:   Thaçi et al. Br J Dermatol 2020; 183 :265–275.