Six months predictors of DAPSA Remission With Guselkumab in Psoriatic Arthritis in a Multicenter Real-World Study

Background
Real-world evidence on 12-month outcomes of guselkumab (GUS) in psoriatic arthritis (PsA) re-
mains limited. This multicenter observational study aimed to identify predictors of 12-month DAPSA
remission (DAPSA <4) in patients with PsA treated with GUS. Secondary objectives were to assess
remission rates and changes in disease activity at 6 and 12 months.
Methods
We screened all patients with PsA initiating GUS across 26 Italian rheumatology centers. Data col-
lected included demographics, disease activity measured by DAPSA, and psoriasis (PsO) extent clas-
sified as 0%, <10%, 10–20%, or >20% body surface area. A multivariable logistic regression model
restricted to patients with an evaluable 6-month assessment was used to identify predictors of 12-
month DAPSA remission. Covariates included age, sex, smoking status, body mass index, disease
duration, number of prior advanced therapies, axial involvement, and 6-month articular and/or cuta-
neous response. Articular response was defined as DAPSA remission (DAPSA <4), and cutaneous
response as improvement by at least one PsO body surface area severity category. A two-sided p
value <0.05 was considered statistically significant.
Results
Of 278 initiators, 199 were evaluable at 6 months. At month 6, 18 patients had a combined articular
and cutaneous response, 9 had an articular-only response, 74 had a cutaneous-only response, and 98
had no response. In intention-to-treat analyses, DAPSA remission was achieved by 12% at 6 months
and 20% at 12 months; corresponding per-protocol rates were 16% and 30%. Median DAPSA de-
ARTICLE IN PRESS
creased from 27.0 at baseline to 11.9 at 6 months and 8.6 at 12 months. In multivariable analysis,
combined response (OR 64.6, 95% CI 5.7–731.2), joint-only response (OR 16.9, 95% CI 4.4–65.2),
and skin-only response (OR 2.5, 95% CI 1.04–6.2) were associated with 12-month DAPSA remis-
sion.
Conclusion
In routine practice, 6-month response status stratified the probability of 12-month DAPSA remission.
Early articular remission and combined articular-cutaneous response showed the strongest associa-
tions, whereas skin-only improvement was a modest but statistically significant predictor and should
not be interpreted as a strong determinant of later articular remission.