Five-year follow-up of guselkumab: clinical cases from real-world practice

Guselkumab is one of the genetically engineered biological drugs intended for the treatment of moderate-to-severe psoriasis and psoriatic arthritis. The drug’s mechanism of action involves the selective blockade of interleukin-23 (IL-23), which suppresses the immune inflammation that develops in psoriasis. The article presents three clinical cases demonstrating the effective use of guselkumab over a five-year follow-up period in adult patients with treatment-resistant widespread plaque psoriasis, including cases of therapy resumption after a forced interruption. Patients were monitored for 5 years (from March 2021 to March 2026) at the Professor Medical Center of the Siberian State Medical University Clinic. In addition to typical plaque lesions, psoriatic onychodystrophy was observed in two patients, scalp psoriasis involving the hairline (“psoriatic crown”) in one patient, and palmoplantar involvement in one patient. Guselkumab was administered in accordance with the manufacturer’s instructions. The disease dynamics was evaluated using the following clinical indices: PASI, NAPSI, BSA and DLQI. Following the treatment, the PASI and DLQI values decreased by 100% from baseline in all observed patients with moderate-to-severe plaque psoriasis. In addition, two patients with nail plate lesions achieved 100% resolution in the NAPSI score. All clinical parameters remained stable during the five-year follow-up. Resumption of guselkumab therapy after a forced interruption (ranging from 3 to 9 months) led to the restoration of baseline treatment efficacy and the achievement of clinical remission in all cases.