APEX Data Reinforce Case For Early PsA Treatment With Guselkumab

“We spend a lot of time talking to patients about all of the potential benefits that can come from early treatment with a highly effective medication. That if we can control their joint and tendon and inflammation and their skin inflammation quickly and toward the beginning of their whole disease process, then we're more likely not to have any major joint deformities, and we have better outcomes from virtually every perspective,” said Philip Mease, MD.

Mease, a rheumatologist and director of rheumatology research at Providence Swedish Medical Center in Seattle, discussed the FDA's recent label expansion for guselkumab (Tremfya; Johnson & Johnson) in psoriatic arthritis. The approval adds inhibition of structural joint damage progression to the drug's label, based on data from the phase 3b APEX trial (NCT04882098).¹ Mease addressed the rationale for treating psoriatic arthritis early with biologic therapy and what delayed-switch data from APEX show about guselkumab's effect once disease progression has already begun.

In a previous interview, Mease reviewed the trial's patient selection strategy, primary results, and safety profile.

Addressing Anxiety About Starting a Biologic

Newly diagnosed patients often hesitate before starting a biologic, Mease said, describing a common reaction to the idea of an injection or infusion after years of oral medications. He said misconceptions about safety contribute to this hesitation, prompting extensive counseling with patients on the benefits of early, effective treatment.

"There's a certain anxiety about going on to a biologic. They might have some misconceptions about the potential safety issues involved," Mease said.

Controlling joint, tendon, and skin inflammation early in the disease process leads to fewer major joint deformities and better outcomes overall, Mease said, including less joint pain, less enthesitis, better skin improvement, and better function and quality of life.

"Enthesis is where a tendon inserts into bone," Mease said. "So, the sooner that we can get to this state of either remission of disease or low disease activity, then the better it is for the patient in the long run."

What Delayed-Switch APEX Data Show

Mease was asked about APEX findings showing a 57% reduction in radiographic progression among patients who switched from placebo to guselkumab at week 24. He said the data support two conclusions: benefit remains possible even after a treatment delay, but the switch does not fully close the gap created by that delay.

"On the one hand, it shows it can work even for patients who were on a period of placebo treatment, and that's good. But it didn't completely catch up with the improvement that occurred in patients treated with guselkumab from the very beginning," Mease said.

Mease said the delayed-switch results reinforce the same theme he raised earlier in the interview.

"That underlines the importance of early treatment before cumulative damage has occurred," Mease said.

Reference

1. FDA approves label expansion, cementing Tremfya as the only IL‑23 inhibitor proven to help stop further joint damage. News release. Johnson & Johnson. May 28, 2026. Accessed July 7, 2026. https://www.jnj.com/media-center/press-releases/fda-approves-label-expansion-cementing-tremfya-as-the-only-il-23-inhibitor-proven-to-help-stop-further-joint-damage