Guselkumab

How it works

It is a human monoclonal antibody that binds the p19 subunit of IL-23, blocking IL-23-driven activation of the Th17 inflammatory pathway.

Prescribing in practice

• It increases susceptibility to infection, so active serious infection should be treated and latent tuberculosis evaluated before starting.
• It is initiated by specialists for patients meeting eligibility criteria for biologic therapy.
• Live vaccines should be avoided during treatment, and hypersensitivity reactions can occur.

Monitoring

Assess for tuberculosis and infection before starting and review treatment response and infection risk during therapy.

Counselling the patient

• Report signs of infection promptly and complete any pre-treatment screening.
• Avoid live vaccines during treatment and update vaccinations beforehand where possible.
• Follow the injection technique taught and store the device as directed.

Evidence & guidelines

Efficacy was demonstrated in the VOYAGE psoriasis and DISCOVER psoriatic arthritis randomised controlled trials.