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Guselkumab, an interleukin-23(p19) inhibitor, is highly effective in moderate-to-severe psoriasis.1 Biologics are recommended by the National Institute of Health and Care Excellence (NICE) in patients who have failed treatment with or have a contraindication to standard systemics such as methotrexate or ciclosporin.2 Fumaric acid esters (FAEs) are used as first-line systemic agents in some countries, while in the UK NICE recommends FAEs in patients who have not responded to other nonbiologic systemic treatments.3,4

In this issue, Thaçi et al. report the results from parts II and III of the POLARIS trial, which examined the long-term efficacy of guselkumab (GUS) in systemic-naïve patients, nonresponders to FAEs and following GUS treatment withdrawal.4 Part I of the trial met the primary objective of GUS superiority over FAEs [week 24; ≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90) (82% vs. 14%)].5 All patients who completed part I were eligible to enter part IIa (weeks 24–32), with GUS (n = 56) or FAE (n = 35) treatment continued. In part IIb (weeks 32–64), PASI 75 responders (i.e. ≥ 75% improvement in PASI) continued treatment, while PASI 75 nonresponders in the FAE group switched to GUS. In part III (weeks 64–100), GUS was stopped in PASI 90 responders at week 56 with patients followed to loss of response (defined as PASI > 5).

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