Guselkumab

Guselkumab, sold under the trade name Tremfya, is a monoclonal antibody against interleukin-23 used for the treatment of plaque psoriasis.[1][2]

Guselkumab
Monoclonal antibody
TypeWhole antibody
SourceHuman
TargetIL23
Clinical data
Trade namesTremfya
AHFS/Drugs.comtremfya
ATC code
Legal status
Legal status
Identifiers
CAS Number
DrugBank
ChemSpider
  • none
UNII
KEGG
Chemical and physical data
FormulaC6402H9864N1676O1994S42
Molar mass143.6 kg/mol g·mol−1

Medical uses

Guselkumab is FDA approved to treat moderate to severe plaque psoriasis in adults.[3] Its use for the treatment of psoriatic arthritis is being explored.[4]

Guselkumab is provided as a subcutaneous injection of 100 mg given every eight weeks (except for the second dose, which is given four weeks after the first dose).[5]

Adverse effects

Because guselkumab lowers the release of immune system signalling molecules, patients may have a higher risk of getting infections from bacteria, viruses, and fungi.[1] For this reason, people with psoriasis being considered for treatment with guselkumab must be screened for tuberculosis infection prior to treatment with guselkumab.[1]

The most common side effects for guselkumab are upper respiratory tract infections, headache, injection site reactions, joint pain, diarrhea, gastroenteritis, fungal skin infections and herpes simplex infections.[3] It is noteworthy that during the studies where side effects were tracked, patients who received a placebo experienced these side effects at rates just slightly lower than the patients who received guselkumab, suggesting guselkumab only marginally increases the risk of having an adverse effect.[3] As guselkumab is a new medicine, the long term effects are not fully understood.[6]

Pharmacology

Mechanism of action

Guselkumab targets the IL-23 subunit alpha (p19 subunit)[7] hence preventing it from binding to cell receptors that would otherwise be activated by its presence.[4]

Pharmacokinetics

Cmax 8.09 µg/mL tmax 5.5 days volume of distribution 13.5 L apparent clearance 0.516 L/day[4]

Commercialization

Guselkumab was developed by Janssen Global Services, LLC.[8] In November 2016, Janssen submitted a Biologics License Application (BLA) to the FDA seeking approval of guselkumab.[9] In July 2017 Janssen gained US FDA approval to market guselkumab for treatment of plaque psoriasis.[10] Usage for psoriatic arthritis has also been approved in Japan as of April 2018.[11] Guselkumab is manufactured by Janssen Sciences Ireland UC in Cork, Ireland. [12]

Cost

The list price of each 100 mg dose (to be given once every two months) is about $10,000.[13]

Research and development

During development, guselkumab was referred to as CNTO-1959.[4] Guselkumab has undergone phase 3 clinical trials comparing it with adalimumab (Humira) and ustekinumab (Stelara).[8]

The safety and efficacy of guselkumab was compared to a placebo and to adalimumab in the "VOYAGE 1" and "VOYAGE 2" phase 3 clinical trials. (ClinicalTrials.gov IDs: NCT02207231 and NCT02207231)[6] While these trials are still ongoing, preliminary results indicate a significantly higher proportion of patients taking guselkumab had better skin clearance compared to those taking the other treatments. At week 16, 73.3% of patients taking guselkumab had a PASI score of 90 vs 49.7% of those taking adalimumab; additionally, 91.2% of patients taking guselkumab had a PASI score of 75, vs 73.1% of those taking adalimumab.[6]

The phase 3 clinical trial "NAVIGATE" (ClinicalTrials.gov ID: NCT02203032) included only patients who had poor responses to treatment with ustekinumab. It showed that patients who switched to guselkumab from ustekinumab did better than those who stuck to ustekinumab.[4]

See also
  • Ustekinumab, a monoclonal antibody targeting both IL-12 and IL-23 and used to treat plaque psoriasis, launched in the United States under the brand name Stelara
  • Tildrakizumab, is a humanized monoclonal IgG1, IL-23-specific antibody approved for the treatment of moderate to severe plaque psoriasis. It is marketed under the brand name Ilumya.

References
  1. Guselkumab Injection: MedlinePlus Drug Information
  2. "Guselkumab". 2012. PMID 31643594. Cite journal requires |journal= (help)
  3. Drug Approvals and Databases > Drug Trials Snapshots: TREMFYA
  4. Markham A (Sep 2017). "Guselkumab: First Global Approval". Drugs. 77 (13): 1487–1492. doi:10.1007/s40265-017-0800-7. PMID 28819723.
  5. JANSSEN ANNOUNCES U.S. FDA APPROVAL OF TREMFYA™ (GUSELKUMAB) FOR THE TREATMENT OF MODERATE TO SEVERE PLAQUE PSORIASIS Johnson & Johnson
  6. Nakamura M, Lee K, Jeon C, Sekhon S, Afifi L, Yan D, Lee K, Bhutani T (Jun 2017). "Guselkumab for the Treatment of Psoriasis: A Review of Phase III Trials". Dermatology and Therapy. 7 (3): 281–292. doi:10.1007/s13555-017-0187-0. PMC 5574739. PMID 28639011.
  7. Oppmann B, Lesley R, Blom B, Timans JC, Xu Y, Hunte B, Vega F, Yu N, Wang J, Singh K, Zonin F, Vaisberg E, Churakova T, Liu M, Gorman D, Wagner J, Zurawski S, Liu Y, Abrams JS, Moore KW, Rennick D, de Waal-Malefyt R, Hannum C, Bazan JF, Kastelein RA (Jan 2001). "Novel p19 protein engages IL-12p40 to form a cytokine, IL-23, with biological activities similar as well as distinct from IL-12". Immunity. 13 (5): 715–25. doi:10.1016/S1074-7613(00)00070-4. PMID 11114383.
  8. Janssen Wins FDA Approval for Plaque Psoriasis Treatment Tremfya. July 2017
  9. Janssen Submits Application to EMA Seeking Approval of Anti-Interleukin-23 Monoclonal Antibody Guselkumab for the Treament of Moderate-to-Severe Plaque Psoriasis
  10. Novel Drug Approvals for 2017
  11. "MorphoSys' licensee Janssen receives Japanese approval for Tremfya to treat moderate to severe forms of psoriasis & psoriatic arthritis". pharmabiz.com. Retrieved 2018-06-05.
  12. Guselkumab BLA Approval Letter
  13. Johnson & Johnson's Tremfya gets its go-ahead to fight Novartis, Lilly in psoriasis. Can it stand out?
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