Guselkumab

Le guselkumab est un anticorps monoclonal dirigé contre l'interleukine 23 et utilisé dans le traitement de certaines formes de psoriasis.

Mode d'action modifier

Il est dirigé contre la sous-unité p19 de l'interleukine 23, empêchant sa fixation à son récepteur et la production de plusieurs cytokines.

Efficacité modifier

Il a testé dans les formes modérées à sévères du psoriasis. Dans les cas résistants à l'ustekinumab, le guselkumab permet d'avoir une amélioration sensible de la maladie dans un peu plus d'un tiers des cas^[1]. Son efficacité est supérieure à celle de l'adalimumab^[2] et à celle du secukinumab^[3]. Il est également actif sur le rhumatisme psoriasique, que cela soit en première^[4] ou en seconde ligne^[5].

Effets secondaires modifier

le guselkumab favorise la survenue d'infections, parfois sévères. Il peut exister une élévation des enzymes hépatiques^[6].

Considérations économiques modifier

Le coût d'une cure, en 2017, est près de 29 000 dollars, ce qui en constitue la biothérapie la plus chère dans le traitement du psoriasis^[6].

Notes et références modifier

↑ Langley RG, Tsai TF, Flavin S et al. Efficacy and safety of guselkumab in patients with psoriasis who have an inadequate response to ustekinumab: results of the randomized, double-blind, phase III NAVIGATE trial, Br J Dermatol, 2017
↑ Blauvelt A, Papp KA, Griffiths CE et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phase III, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial, J Am Acad Dermatol, 2017;76:405-417
↑ Reich K, Armstrong AW, Langley RG et al. Guselkumab versus secukinumab for the treatment of moderate-to-severe psoriasis (ECLIPSE): results from a phase 3, randomised controlled trial, Lancet, 2019;394:831-839
↑ Mease PJ, Rahman P, Gottlieb AB et al. Guselkumab in biologic-naive patients with active psoriatic arthritis (DISCOVER-2): a double-blind, randomised, placebo-controlled phase 3 trial, Lancet, 2020;395:1126-1136
↑ Deodhar A, Helliwell PS, Boehncke W-H et al. Guselkumab in patients with active psoriatic arthritis who were biologic-naive or had previously received TNFα inhibitor treatment (DISCOVER-1): a double-blind, randomised, placebo-controlled phase 3 trial, Lancet, 2020;395:1115-1125
↑ ^{a et b} Guselkumab (Tremfya) for psoriasis, JAMA, 2017;318:2487-2488

[Langley_2017-1] Langley RG, Tsai TF, Flavin S et al. Efficacy and safety of guselkumab in patients with psoriasis who have an inadequate response to ustekinumab: results of the randomized, double-blind, phase III NAVIGATE trial, Br J Dermatol, 2017

[Blauvelt_2017-2] Blauvelt A, Papp KA, Griffiths CE et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phase III, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial, J Am Acad Dermatol, 2017;76:405-417

[Reich_2019-3] Reich K, Armstrong AW, Langley RG et al. Guselkumab versus secukinumab for the treatment of moderate-to-severe psoriasis (ECLIPSE): results from a phase 3, randomised controlled trial, Lancet, 2019;394:831-839

[Mease_2020-4] Mease PJ, Rahman P, Gottlieb AB et al. Guselkumab in biologic-naive patients with active psoriatic arthritis (DISCOVER-2): a double-blind, randomised, placebo-controlled phase 3 trial, Lancet, 2020;395:1126-1136

[Deodhar_2020-5] Deodhar A, Helliwell PS, Boehncke W-H et al. Guselkumab in patients with active psoriatic arthritis who were biologic-naive or had previously received TNFα inhibitor treatment (DISCOVER-1): a double-blind, randomised, placebo-controlled phase 3 trial, Lancet, 2020;395:1115-1125

[JAMA_2017-6] {a et b} Guselkumab (Tremfya) for psoriasis, JAMA, 2017;318:2487-2488

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