Guselkumab in patients with scalp psoriasis: A post hoc analysis of the VOYAGE 2 trial

Scalp involvement is common in patients with psoriasis, is often associated with itch, and significantly impacts quality of life [1,2]. The Phase III VOYAGE 2 trial compared guselkumab, an interleukin-23(p19) inhibitor, with placebo and with adalimumab in patients with moderate-to-severe plaque psoriasis [3]. This post hoc analysis explored scalp responses during guselkumab treatment and withdrawal in patients with scalp involvement (as indicated at screening) who were randomised to guselkumab 100 mg at Week (W)0 and W4, then every 8 weeks. At W28, Psoriasis Area and Severity Index (PASI) 90 responders were re-randomised to continue (n=159) or discontinue (n=164) guselkumab; non-responders continued guselkumab (n=84). Among guselkumab responders remaining on treatment, mean scalp-specific Investigator Global Assessment (ss-IGA) score rapidly declined from 2.9 at W0 to 0.2 at W24, and 0.3 at W48; mean PASI head scores were 2.0, 0.1 and 0.1, respectively, and were consistent with total PASI score improvements (21.9, 0.6 and 1.0, respectively). Changes in ss-IGA and PASI scores were less marked in non-responders than responders, but also showed improvements. Guselkumab responders who had treatment withdrawn showed an increase in mean ss-IGA score from 0.2 (W24) to 1.3 (W48) and mean PASI head score (0.1 to 0.6, respectively). Changes in mean Psoriasis Symptoms and Signs Diary itch scores and Dermatology Life Quality Index scores paralleled changes in mean ss-IGA scores for all cohorts. Guselkumab demonstrated rapid and durable clinical efficacy, itch relief and quality-of-life improvements in patients with scalp psoriasis. Further investigation is required to understand predictors of scalp response.