From the Guidelines
At routine follow-up for patients taking Tremfya (guselkumab) for psoriasis, clinicians should evaluate treatment efficacy, safety, and tolerability, with a focus on assessing response to treatment with IL-12/23 inhibitors, which is best ascertained after 12 weeks of continuous therapy 1. When evaluating patients on Tremfya, it is essential to consider the following key aspects:
- Assessment of skin for psoriasis improvement using standardized measures like PASI score or BSA affected
- Monitoring for potential adverse effects, including infections, injection site reactions, and hypersensitivity reactions
- Laboratory monitoring, such as complete blood count, liver function tests, and tuberculosis screening (annually)
- Patient questioning about new symptoms, infections, or other health concerns
- Mental health status assessment, as psoriasis can impact psychological wellbeing
- Review of medication adherence and injection technique, along with any barriers to treatment The timing of follow-up visits typically occurs at 3-6 month intervals after initial stabilization, though this may vary based on individual patient factors 1. Key considerations for follow-up evaluations include:
- Definitive response to treatment with IL-12/23 inhibitors, such as Tremfya, is best ascertained after 12 weeks of continuous therapy 1
- Dose adjustments may be necessary based on clinical response 1
- Combination therapy with other agents, such as topical treatments, acitretin, methotrexate, or apremilast, may be considered in certain cases, but the long-term safety of these combinations is not well studied 1
From the Research
Evaluation Parameters for Patients Taking Tremfya (Guselkumab) for Psoriasis
At routine follow-up for patients taking Tremfya (Guselkumab) for psoriasis, the following parameters should be evaluated:
- Psoriasis Area and Severity Index (PASI) score to assess the severity of psoriasis and response to treatment 2, 3, 4, 5
- Dermatology Life Quality Index (DLQI) score to evaluate the impact of psoriasis on health-related quality of life 3, 6
- Investigator's Global Assessment (IGA) score to assess the overall severity of psoriasis and response to treatment 2, 6
- Psoriasis Symptoms and Signs Diary (PSSD) scores to evaluate symptoms and signs of psoriasis 3, 6
- Body surface area (%) to assess the extent of psoriasis involvement 3
- Presence of difficult-to-treat areas, such as scalp, palms, soles, and nails, to evaluate the effectiveness of treatment in these areas 3, 5
- Body mass index (BMI) to assess the potential impact of obesity on treatment response 2, 5
Factors Predicting Treatment Response
Several factors have been identified as predictors of treatment response to guselkumab, including:
- Patient age, with younger patients more likely to achieve complete skin clearance 2
- Baseline body weight, with patients weighing ≤90 kg more likely to achieve complete skin clearance 2
- Baseline PASI score, with patients having less severe psoriasis more likely to achieve complete skin clearance 2
- Baseline IGA score, with patients having less severe psoriasis more likely to achieve complete skin clearance 2
Safety Evaluation
No new safety signals were observed in the studies evaluating the effectiveness and safety of guselkumab in patients with psoriasis 3, 5. However, it is essential to continue monitoring patients for potential adverse events and adjust treatment accordingly.