Guselkumab

How it works

It selectively binds the p19 subunit of interleukin-23, blocking IL-23 signalling and downstream Th17 activation that drives psoriatic inflammation.

Prescribing in practice

• As an immunosuppressant biologic it increases infection risk, so screen for and treat latent tuberculosis and active infection before starting and remain vigilant during treatment.
• Live vaccines should be avoided during treatment; ensure immunisations are up to date beforehand.
• It is reserved for patients meeting disease-severity and prior-therapy criteria for systemic biologic treatment.

Monitoring

Monitor for signs of infection throughout treatment and assess psoriasis response at the recommended review point to judge continuation.

Counselling the patient

• Report fever, persistent cough or other signs of infection promptly.
• Tell any clinician you are on a biologic medicine before having vaccinations.
• Self-injection technique and safe needle disposal will be taught before home administration.

Evidence & guidelines

NICE has recommended guselkumab as an option for treating severe plaque psoriasis within its technology appraisal criteria.