Expert commentary: The DISCOVER trials | Oliver FitzGerald

Expert commentary: The DISCOVER trials | Oliver FitzGerald


[MUSIC PLAYING] They offer another treatment
option for patients with psoriatic arthritis,
which is the first thing. It does look like
guselkumab results in a significant improvement
in the primary outcome measure of the ACR20 measure
in both the DISCOVER-1 and DISCOVER-2 trials. DISCOVER-1 being patients
who were previously exposed to a TNF inhibitor– or included patients
who were previously exposed to a TNF inhibitor. Whereas the DISCOVER-2 includes
the whole question of effect on radiographic outcomes. So it works for both, and
both groups of patients. And it works for all
the aspects of disease, not just joint disease. It looks like it’s
particularly effective for skin disease, which isn’t surprising
given the data in psoriasis. But other features, like
enthesitis and dactylitis also significantly
improve with many patients reaching dactylitis
and enthesitis scores of zero, complete
resolution with guselkumab. It compares favorably
with other treatments. Because of its effect
on skin disease– they haven’t been
compared head to head– but it’s likely to be
more efficacious than some of the treatments that are
currently available in terms of that particular aspect. So I can certainly
see if a patient has a lot of skin disease,
that guselkumab would be a reasonable
medication to choose. I guess one of
the challenges is, you know, for other
aspects of disease, how do we know that guselkumab
is going to be the best choice for those patients. The data would suggest
that it also, as I say, works well for patients who
have dactylitis and enthesitis. So maybe patients who have
bad skin disease, dactylitis, enthesitis, and joint disease– maybe they’re the
ones to focus on. The first biologic that
was approved for treatment on psoriatic arthritis are
the anti-TNF inhibitors, as you know. And they’ve always been a
hard group to compare with. Because they have
been very effective over many years and
many people feel comfortable with
using anti-TNFs. But I suspect that
over time, guselkumab– there will be good
take up of guselkumab within the psoriatic
arthritis community. In particular, as people– as dermatologists are using
it in patients with psoriasis, rheumatologists would
become more familiar with it and more comfortable with it. So I think I think
it will certainly have an impact on the
landscape for what we’re using. I think it’s great news. We have yet another choice. We need to understand better– to answer your
question– which patients we should be using
which drug in. And that, I think, is
the big challenge for us at the present. Now with this large
group of medications that we have available
for psoriatic arthritis is how to select out which
treatment is going to work for which individual patients. So that’s going to be
a particular focus, I think, over the
next few years. [MUSIC PLAYING]

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