Psoriasis Hyperuricemia and Tremfya

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In this retrospective cohort of 228 Chinese patients with chronic plaque psoriasis, 52 weeks of Tremfya (guselkumab) treatment was associated with a modest but statistically significant reduction in serum uric acid.

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Background:
Hyperuricemia (HUA) is common in psoriasis, but the effect of selective interleukin (IL)-23 inhibition on serum uric acid (UA) is inconsistent.

Methods:
In this two-center retrospective cohort, 228 adults with chronic plaque psoriasis received guselkumab for 52 weeks. The primary outcome was the change in UA (ΔUA). Secondary outcomes included HUA resolution, new-onset HUA, predictors of baseline HUA and HUA resolution, and the association of ΔUA with Psoriasis Area and Severity Index (PASI) response and change in high-sensitivity C-reactive protein (ΔhsCRP).

Results:
At baseline, 92 patients (40.4%) had HUA. UA decreased in the overall cohort (median ΔUA −10.5 μmol/L; bootstrap 95% CI −19.0 to −3.0; p < 0.001), with the largest reduction among baseline HUA patients (median −35.5 μmol/L; 95% CI −53.5 to −17.0), 32.6% of whom achieved HUA resolution; cohort HUA prevalence fell from 40.4% to 33.3% (McNemar p = 0.023). 10.3% of patients with normal baseline UA developed new-onset HUA. ΔUA correlated weakly with ΔhsCRP but not with PASI change. Male sex and higher BMI independently predicted baseline HUA; lower baseline total cholesterol and higher baseline PASI independently predicted HUA resolution.

Conclusion:
Guselkumab was associated with a statistically significant but modest UA reduction, which was largest in patients with HUA and was independent of skin clearance over 52 weeks, suggesting an ancillary metabolic effect of IL-23 inhibition that warrants prospective confirmation.

Source: onlinelibrary.wiley.com

*Funding: Peking Union Medical College Hospital. National Natural Science Foundation of China. Natural Science Foundation of Beijing Municipality. National High Level Hospital Clinical Research Funding

Tremfya (guselkumab)