P124 Real-world effectiveness of guselkumab in moderate-to-severe plaque psoriasis with high-impact-site involvement: evidence from the British Association of Dermatologists Biologics and Immunomodulators Register

Abstract

The burden of high-impact-site involvement (HISI) including palms, nails, scalp and flexures in psoriasis is substantial. However, real-world UK data on biologic effectiveness for treating these areas remain limited. Our aim was to evaluate drug survival and clinical response to guselkumab, an interleukin-23p19 ­subunit-targeting monoclonal antibody, in patients with HISI. This retrospective observational study used deidentified data from the British Association of Dermatologists Biologic and Immuno­modulators Register (BADBIR) collected from January 2018 to August 2024. In total, 600 adults with moderate-to-severe plaque psoriasis were identified who commenced guselkumab and had documented drug survival and Psoriasis Area and Severity Index (PASI) scores through to 48 months. Outcomes of those with HISI were analysed overall and by subtype (palm, nail, scalp, flexural). Drug survival was assessed using Kaplan–Meier methods, and PASI change at month 48 was analysed in patients with available scores at baseline (± 3 months from guselkumab initiation) and month 48 (± 3 months). In total, 155 patients had HISI (palms, 42; nails, 96; scalp, 130; flexural, 67). The mean (SD) age at baseline was 47 (15) years and 65% were male. Overall, 94% of patients with HISI had received at least one prior systemic therapy and 29% had at least one prior biologic therapy. At baseline, 74% of patients with documented scores (95 of 128) had a PASI ≥ 10, with a mean (SD) PASI of 14 (8). At 48 months, 73% (95% confidence interval 66–80) of patients with HISI remained on treatment; continuation rates were similar across subtypes. Mean PASI improvement between baseline and month 48 was 11.2 (95% confidence interval −13.4 to −9.0); 85% achieved PASI 75 and 72% PASI 90, and 66% had a PASI score < 1, with similar trends across subtypes. In conclusion, data from BADBIR demonstrated sustained drug survival and clinically meaningful improvements with guselkumab treatment over 48 months in patients with HISI, regardless of site, supporting its effectiveness in real-world UK practice for these traditionally harder-to-treat psoriasis subtypes. This study was funded by Janssen Cilag Ltd.