Findings from an analysis of the DISCOVER-1 and DISCOVER-2 trials suggest treatment with guselkumab increases hemoglobin levels and lessens the prevalence of anemia among patients with psoriatic arthritis (PsA).

These findings were presented by Arthur Kavanaugh, MD, from the University of California San Diego in La Jolla, California, at the virtual American College of Rheumatology Convergence 2021.

“Anemia related to systemic inflammation can be an important feature of PsA,” explained Dr Kavanaugh and colleagues.

This analysis assessed the effect of guselkumab on anemia in patients with active PsA in the phase 3 DISCOVER-1 and DISCOVER-2 trials, in which 1120 patients with active PsA were randomized in a 1:1:1 ratio to receive guselkumab 100 mg ever 4 weeks (Q4W), guselkumab 100 mg at week 1, week 4, then every 8 weeks (Q8W); or placebo; given for 1 year (DISCOVER-1) or 2 years (DISCOVER-2).

Mean hemoglobin levels and the number of patients with anemia were assessed by treatment group through 1 year. A logistic regression model estimated odds ratios and 95% confidence interval for achieving anemia resolution.

The binary end point was anemia responder status at week 24. Age, sex, swollen and tender joint count, and C-reactive protein were assessed as predictors of anemia response.

A total of 1074 patients were included in the analysis. At baseline, about 24% of male (n = 136) and female (n = 120) patients were anemic. Mean hemoglobin levels were <13.5 g/dL and <12 g/dL, respectively. Patients with anemia had more swollen and tender joints, systemic inflammation, and fatigue than patients without anemia.

For both guselkumab treatment groups, mean hemoglobin levels increased from baseline through week 24 for both male and female patients, particularly for those who were anemic at baseline. For the placebo group, mean hemoglobin levels were unchanged from baseline through week 24. For patients who switched from placebo to guselkumab at week 24, hemoglobin levels increased similar to levels seen in patients randomized to guselkumab.

The proportions of patients meeting criteria for anemia decreased over time. Male patients exhibited more rapid response than female patients.

Patients with anemia at baseline, but not at week 24 (anemia resolution) were majority male and had shorter duration of PsA and lower c-reactive protein levels at baseline than those with unresolved anemia at week 24.

Logistic regression analyses confirmed that female patients and patients with higher baseline c-reactive protein levels were significantly less likely to achieve anemia resolution at week 24 than male patients and patients with lower baseline c-reactive protein.

Patients with anemia resolution (n = 112) appeared to exhibit better outcomes at week 24 than patients with unresolved anemia (n = 136), with fewer mean swollen and tender joints (4.8 vs 6.2, respectively), less systemic inflammation (10.7 vs 12.5), and less fatigue (37.4 vs 33).

Overall, guselkumab treatment through week 52 increased hemoglobin levels and lessened the prevalence of anemia in both male and female patients with active PsA. Anemia resolution was associated improved clinical status compared to those with persistent anemia.

--Janelle Bradley

Reference:

Kavanaugh A, Liu Y, Rahman P, et al. Guselkumab (TREMFYA®) improves anemia in patients with active psoriatic arthritis: results from two phase 3 randomized controlled clinical trials. Presented at: American College of Rheumatology Convergence 2021; November 5-9, 2021; virtual. Abstract 1331.