Super‐Response to Guselkumab Treatment in Patients With Moderate‐to‐Severe Psoriasis: Real‐World Data With Up to Five Years of Follow‐Up in The Czech Republic

BACKGROUND: Guselkumab, a selective interleukin (IL)-23 inhibitor, is approved for the treatment of moderate-to-severe plaque psoriasis. While randomized clinical trials have introduced the concept of "super-responders" (SRe)-patients achieving complete skin clearance (Psoriasis Area and Severity Index [PASI] 100) at defined early timepoints-real-world evidence on their characteristics and long-term outcomes remains limited. This study aimed to identify baseline predictors of super-response (PASI 100 at Weeks 16 and 24) and to evaluate long-term effectiveness, safety, and drug survival over a 5-year period in a routine clinical setting. METHODS: This retrospective multicenter study analyzed 435 patients from the Czech BIOREP registry treated with guselkumab. Predictors of super-response were identified using multivariable logistic regression. PASI outcomes and drug survival were assessed with descriptive statistics and Kaplan-Meier analysis. RESULTS: Among the cohort, 130 patients (29.9%) were classified as super-responders. Lower body mass index (BMI) and absence of prior biologic therapy were independent predictors of SRe status (odds ratio [OR] = 0.94 and 0.73, respectively). While PASI 75/90/100 rates were significantly higher in SRe throughout follow-up, drug survival was comparable between SRe and non-SRe. At 60 months, PASI 100 was maintained in 79.2% of SRe versus 35.4% of non-SRe. Obesity and female sex were associated with lower long-term treatment persistence. CONCLUSIONS: Super-response to guselkumab is linked to distinct baseline features. Despite differences in PASI outcomes, treatment persistence was similar across groups. These findings underscore the value of early identification of super-responders and support personalized treatment strategies in clinical practice.