Tremfya for Psoriasis: A New Horizon in Treatment Efficacy

April 14, 2024

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Psoriasis is a chronic inflammatory skin condition affecting over 8 million Americans. This immune-mediated disease causes rapid buildup of skin cells, forming thick, silvery scales and red plaques that can be painful, itchy and disfiguring. While symptoms come and go unpredictably, there is no cure for psoriasis. However, the FDA approval of Tremfya (guselkumab) in 2017 marked a turning point in treatment.

Overview of Psoriasis

Psoriasis occurs when the immune system overreacts, triggering inflammation and excessive skin cell replication. Extra cells pile up rapidly on the surface forming plaques – thick, scaly lesions classically seen in plaque psoriasis, the most common type. Genes, infections and stress can trigger flares.

While not contagious, the unsightly appearance causes emotional distress. Common problem areas include the scalp, hands, feet, nails, folds like the armpits and groin, along with the limbs and torso. Up to 30% of patients eventually develop painful psoriatic arthritis.

Evolution of Psoriasis Treatment

Despite decades researching the autoimmune pathology of psoriasis, effective treatment remained elusive until the early 2000s. Older systemic drugs like methotrexate helped some patients but carry risks like liver damage. Phototherapy using UV light also has limitations.

The introduction of biologic medications revolutionized treatment by specifically targeting overactive immune pathways underlying this complex disease. The first wave of TNF-inhibitors brought relief to many previously resistant cases. Then came more advanced IL-23 and IL-17 inhibitors like Tremfya.

Understanding Tremfya (Guselkumab)

Tremfya is the brand name of the injectable biologic drug guselkumab, first approved by the U.S. FDA in 2017 for treating moderate-severe plaque psoriasis in adults. It was the first IL-23 blocker approved. IL-23 is an inflammatory protein that drives symptom progression.

Tremfya is a human monoclonal antibody that binds to the IL-23 receptor, blocking the pathway that leads to the rapid turnover of skin cells and scales forming on the surface seen in psoriasis plaques.

It was specifically designed not to affect any pathways in the immune system unrelated to psoriasis. By selectively targeting IL-23, Tremfya avoids broadly suppressing the immune system.

Approved Uses of Tremfya

Tremfya injection is FDA approved for treating plaque psoriasis and psoriatic arthritis in adults:

  • Plaque psoriasis – Clears or almost clears moderate-severe skin plaques in 85% of patients. Provides complete remission for some.
  • Psoriatic arthritis – Significantly improves joint pain, swelling and mobility issues for many. Slows disease progression.

It can also improve difficult manifestations like scalpnailhand & foot psoriasis unresponsive to other treatments. Researchers continue investigating expanded applications.

How Tremfya Works

Tremfya is the brand name of the active drug guselkumab. Here’s how this revolutionary IL-23 inhibitor controls plaque psoriasis:

  1. Guselkumab is a lab-generated human monoclonal antibody
  2. It is injected under the skin and circulates in bloodstream
  3. Guselkumab recognizes and binds to the IL-23 receptor
  4. By attaching to the receptor, guselkumab blocks IL-23 connection
  5. With IL-23 activity obstructed, inflammation cascade shuts down
  6. Without ongoing inflammation, rapid skin turnover decreases
  7. As fewer new skin cells accumulate, plaques clear and symptoms improve

So by selectively impeding IL-23 signaling using guselkumab, the unchecked inflammation driving psoriasis is relieved.

Tremfya Efficacy for Treating Plaque Psoriasis

In extensive clinical trials with over 2000 patients, Tremfya produced significant skin clearance within just 16 weeks:

✅ Up to 85-90% achieved 90% clearer skin or complete plaque resolution
✅ 75% reached PASI 75 by week 4 (75% improvement in Psoriasis Area and Severity Index score)
✅ Improvement continued over 48 weeks with every-other-month injections

Such substantial clearing of moderate-severe psoriasis plaques is very impressive – exceeding results from older biologics. The convenience of injections just 4 times yearly is also advantageous for patients.

Advantages and Disadvantages of Using Tremfya

Key advantages of Tremfya psoriasis treatment include:

✅ Rapid, substantial skin clearance – plaque thinning by 75% in a month
✅ Allows lower dosing frequency – just one shot every 8 weeks
✅ Safe for long-term chronic psoriasis management
✅ Fewer side effects than older biologics
✅ Option for joint symptoms since also approved for psoriatic arthritis

Potential disadvantages requiring consideration:

❌ Requires regular travel for in-office injections
❌ Can permit certain infections or cancers since suppresses immunity
❌ Much more costly than older oral/topical psoriasis medications
❌ Lifelong adherence required to maintain control of symptoms
❌ Not approved for all autoimmune disorders like Crohn’s or rheumatoid arthritis

Still, for most dermatologists and patients Tremfya’s substantial efficacy outweighs the disadvantages of using this advanced IL-23 inhibitor option.

Tremfya Administration, Dosing and Duration

Tremfya is administered by subcutaneous injection. After starter doses at weeks 0 and 4, maintenance shots are only needed every 8 weeks. It can be injected by a healthcare provider or self-administered after proper training.

The standard dose is 100mg by injection under skin. Each single-dose prefilled syringe or autoinjector pen provides one full dose. Tremfya onset of action varies – maximum efficacy is seen around week 16 for psoriasis, and by week 24 for psoriatic arthritis.

Duration is long-term for suitable patients. Like other immunomodulators, stopping Tremfya can allow recurrence of psoriasis flares. Patients using it for years often sustain initial improvements. Some develop antidrug antibodies reducing effectiveness over longer durations.

Safety Profile and Side Effects of Tremfya

Side effects tend to be mild, generally tolerable:

  • Most common: upper respiratory infections, headache, fatigue, diarrhea
  • Injection site reactions: redness, swelling, itching
  • Increased infections requiring antibiotics in 6%
  • Allergic reaction risk with monoclonal antibody drugs

As Tremfya modulates the immune response, it may increase susceptibility to serious infections or new/worsening cancers. Monitoring for signs of infection along with skin checks for suspicious lesions during treatment is essential. Healthcare providers evaluate whether benefits outweigh potential risks.

Cost and Insurance Coverage of Tremfya

The list price of Tremfya is over $6000 per injection. Given the need for lifelong treatment, the cumulative cost is high. Out-of-pocket expense to the patient varies greatly depending on their health insurance plan.

Most private insurers and government plans like Medicare/Medicaid cover Tremfya since it is FDA-approved to treat a debilitating medical condition. But coverage details differ, so understanding specific plan benefits is important. The manufacturer offers an assistance program to help qualifying patients manage copays.

Patient Support Services for Accessing Tremfya

The injection biologic drug Tremfya offers psoriasis/psoriatic arthritis patients meaningful improvements in disease burden and quality of life. But treatment does require significant commitment in terms of administration, cost and safety monitoring from patients and healthcare providers.

To promote proper use and access, the maker provides valuable support services like:

☑ Product fulfillment assistance
☑ Injection training guides/videos
☑ Financial assistance advisors ☑ Ongoing patient care resources

Utilizing available support helps patients navigate insurance, affordability and healthcare provider coordination concerns on the path to attaining real-world benefits from Tremfya.

Frequently Asked Questions About Tremfya for Psoriasis

How fast does Tremfya work for psoriasis?

Some patients see reductions in plaques within 4 weeks, with more substantial clearance over 3-4 months. Maximum results are typically seen around 4 months into treatment, with further improvements possible up to 1 year.

What percentage of patients with psoriasis respond to Tremfya?

In clinical studies, approximately 85-90% of patients achieve 90% clearance or complete resolution of psoriasis plaques after 6 months of treatment with Tremfya. Such high efficacy exceeds response rates of older biologics.

Is Tremfya safer than other psoriasis biologic drugs?

Yes, Tremfya appears to have a safer profile with less risk of infections or other side effects compared to some TNF-inhibitors and IL-17 blockers used for psoriasis. But as it still suppresses immune pathways, ongoing monitoring for adverse effects is required.

Can Tremfya be used long term for psoriasis?

Tremfya can be safe for long-term psoriasis treatment lasting years. Like other immunomodulators, stopping Tremfya results in disease recurrence over weeks to months. Sustained use helps maintain control of plaque psoriasis.

What should I avoid while taking Tremfya?

Avoid infections to the extent possible and use good hygiene/handwashing habits. Promptly treat any suspected infections. Avoid live vaccines also. Use sun protection since sunlight can trigger plaques. Avoid pregnancy also, along with alcohol excess and smoking which increase some health risks.


  • Psoriasis is an incurable autoimmune skin disorder causing inflammation and rapid skin cell overgrowth
  • Resulting plaques with thick, silvery scales cause emotional and physical distress
  • Older systemic drugs and light therapy helped only mildly and unpredictably
  • Biologics like etanercept, adalimumab and secukinumab partly fulfilled unmet needs
  • The IL-23 inhibitor guselkumab (Tremfya) smartly targets specific pathology
  • Phase 3 trials data clearly demonstrated Tremfya’s superior efficacy for severe plaque psoriasis
  • Substantial plaque clearance for most patients supports its first-line positioning
  • Though expensive and requiring strict follow-ups, Tremfya meaningfully raises the standard for enduring psoriasis control

In just five years, the innovative biologic Tremfya has secured a commanding role in systemic psoriasis treatment – finally offering patients consistent, extensive suppression of deforming skin plaques. While access barriers like cost need addressing, Tremfya exemplifies the profound lifecycle benefits arising from advances in biomedicine.

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