Guselkumab
JFDA label: Tremfya
Mechanism of Action
Inhibitor of Interleukin-23 — Interleukin-23 inhibitor
| Target | Action | Gene / class |
|---|---|---|
| Interleukin-23 efficacy | INHIBITOR |
Indications
Approved
- Plaque psoriasis
Contraindications
Source: Lexicomp
- There are no contraindications listed in the manufacturer's labeling. Canadian labeling (not in the US labeling): Serious hypersensitivity to guselkumab or any component of the formulation Absolute
Adverse Reactions
Nervous system disorders (1)
Common Headache
Hepatobiliary disorders (1)
Common Increased liver enzymes
Immune system disorders (1)
Common Antibody development
Gastrointestinal disorders (2)
Common Diarrhea · gastroenteritis
Skin and subcutaneous tissue disorders (1)
Common Tinea
Musculoskeletal and connective tissue disorders (1)
Common Arthralgia
Infections and infestations (2)
Very Common Infection
Common Herpes simplex infection
General disorders and administration site conditions (1)
Common Injection site reaction
Respiratory, thoracic and mediastinal disorders (1)
Very Common Upper respiratory tract infection
Dosing
Source: Lexicomp
Warnings & Precautions
Source: Lexicomp
Infections
Guselkumab may increase the risk of infections; upper respiratory tract infections, gastroenteritis, tinea infections, and herpes simplex infections have occurred more frequently. Consider the risks versus benefits prior to treatment initiation in patients with a history of chronic or recurrent infection; treatment should not be initiated in patients with clinically important active infections until it is resolved or treated. Monitor for infections; patients should seek medical attention for signs/symptoms of a clinically important infection (acute or chronic). If a serious infection develops or is unresponsive to appropriate therapy for the infection, monitor closely and discontinue guselkumab until the infection resolves.
Tuberculosis
Patients should be evaluated for tuberculosis (TB) infection prior to initiating therapy. Do not administer to patients with an active TB infection. Treatment for latent TB should be administered prior to administering guselkumab. Consider anti-TB therapy prior to treatment initiation in patients with a history of latent or active TB in whom an adequate course of TB treatment cannot be confirmed. Monitor closely for signs/symptoms of active TB during and after guselkumab treatment. Other warnings/precautions:
Immunizations
Patients should be brought up to date with all immunizations before initiating therapy. Live vaccines should not be given concurrently; there are no data available concerning secondary transmission of infection by live vaccines in patients receiving therapy.
Pregnancy & Lactation
Pregnancy
Guselkumab is a monoclonal IgG antibody. Human IgG is known to cross the placenta; therefore, exposure to the fetus may occur if administered to pregnant women.
Lactation
It is not known if guselkumab is present in breast milk. However, guselkumab is a monoclonal IgG antibody; human IgG is known to be present in human milk. According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.
Monitoring
| Clinical pearl | Tuberculosis screening (prior to initiating and periodically during therapy); signs and symptoms of infection, including tuberculosis (during and after treatment). |
|---|
Biology & Pharmacokinetics
Pharmacokinetics
| Bioavailability | 49.0% |
|---|---|
| Half-life | 15 to 18 days |
Drug–drug interactions (100+, DDInter)
| Interacting drug | Severity | Management |
|---|---|---|
| Adalimumab | major | |
| Bacillus calmette-guerin substrain tice live antigen | major | |
| Baricitinib | major | |
| Certolizumab pegol | major | |
| Cladribine | major | |
| Etanercept | major | |
| Fingolimod | major | |
| Golimumab | major | |
| Infliximab | major | |
| Leflunomide | major | |
| Measles virus vaccine live attenuated | major | |
| Mumps virus strain B level jeryl lynn live antigen | major | |
| Natalizumab | major | |
| Ozanimod | major | |
| Rotavirus vaccine | major | |
| Rubella virus vaccine | major | |
| Siponimod | major | |
| Smallpox (Vaccinia) Vaccine, Live | major | |
| Talimogene laherparepvec | major | |
| Teriflunomide | major | |
| Tofacitinib | major | |
| Typhoid vaccine (live) | major | |
| Upadacitinib | major | |
| Varicella Zoster Vaccine (Recombinant) | major | |
| Yellow Fever Vaccine | major | |
| Alefacept | moderate | |
| Alemtuzumab | moderate | |
| Alprazolam | moderate | |
| Aminophylline | moderate | |
| Amiodarone | moderate | |
| Amlodipine | moderate | |
| Anakinra | moderate | |
| Anthrax vaccine | moderate | |
| Apixaban | moderate | |
| Atorvastatin | moderate | |
| Azathioprine | moderate | |
| Benzhydrocodone | moderate | |
| Bifidobacterium longum infantis | moderate | |
| Buprenorphine | moderate | |
| Canakinumab | moderate |
Showing 40 of 100+.
Registered Products (2)
| Brand | Form / strength | Pack | Agent | Citizen (JOD) |
|---|---|---|---|---|
| Tremfya | Pre-filled Syringe 100 mg/1 ml | 1 PFS pack varies | Shawi & Rushedat Drug Store | — |
| Tremfya | Solution 100 mg/1 ml | 100 mg pack varies | Shawi & Rushedat Drug Store | — |