Medical Editor: John P. Cunha, DO, FACOEP
What Is Tremfya?
Tremfya (guselkumab) injection, for subcutaneous use is an interleukin-23 blocker indicated for the treatment of adult patients with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy.
What Are Side Effects of Tremfya?
Common side effects of Tremfya include:
- upper respiratory infections,
- injection site reactions,
- joint pain,
- gastroenteritis (nausea, vomiting, diarrhea, cramps, and fever),
- tinea infections (athlete's foot, ringworm, jock itch), and
- herpes simplex infections
Dosage for Tremfya
The dose of Tremfya is 100 mg administered by subcutaneous injection at Week 0, Week 4 and every 8 weeks thereafter.
What Drugs, Substances, or Supplements Interact with Tremfya?
Tremfya may interact with "live" vaccines and CYP450 substrates. Tell your doctor all medications and supplements you use and all vaccines you recently received.
Tremfya During Pregnancy and Breastfeeding
Tell your doctor if you are pregnant or plan to become pregnant before using Tremfya; it is unknown how it would affect a fetus. Human IgG antibodies are known to cross the placental barrier; therefore, Tremfya may be transmitted from the mother to the developing fetus. It is unknown if Tremfya passes into breast milk. Consult your doctor before breastfeeding.
Our Tremfya (guselkumab) Injection, for Subcutaneous Use Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
The following adverse reactions are discussed in greater detail in other sections of labeling:
- Infections [see WARNINGS AND PRECAUTIONS]
- Hypersensitivity Reactions [see CONTRAINDICATIONS and WARNINGS AND PRECAUTIONS]
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
In clinical trials, a total of 1823 subjects with moderate-to-severe plaque psoriasis received TREMFYA. Of these, 1393 subjects were exposed to TREMFYA for at least 6 months and 728 subjects were exposed for at least 1 year.
Data from two placebo- and active-controlled trials (PsO1 and PsO2) in 1441 subjects (mean age 44 years; 70% males; 82% white) were pooled to evaluate the safety of TREMFYA (100 mg administered subcutaneously at Weeks 0 and 4, followed by every 8 weeks).
Weeks 0 To 16
In the 16-week placebo-controlled period of the pooled clinical trials (PsO1 and PsO2), adverse events occurred in 49% of subjects in the TREMFYA group compared to 47% of subjects in the placebo group and 49% of subjects in the U.S. licensed adalimumab group. Serious adverse events occurred in 1.9% of subjects in the TREMFYA group (6.3 events per 100 subject-years of follow-up) compared to 1.4% of subjects in the placebo group (4.7 events per 100 subject-years of follow-up), and in 2.6% of subjects in U.S. licensed adalimumab group (9.9 events per 100 subject-years of follow-up).
Table 1 summarizes the adverse reactions that occurred at a rate of at least 1% and at a higher rate in the TREMFYA group than in the placebo group during the 16-week placebo-controlled period.
Table 1: Adverse Reactions Occurring in ≥1% of Subjects through Week 16 in PsO1 and PsO2
|TREMFYAa 100 mg|
|Upper respiratory infectionsc||118 (14.3)||21 (10.7)||54 (12.8)|
|Headached||38 (4.6)||2 (1.0)||14 (3.3)|
|Injection site reactionse||37 (4.5)||15 (7.7)||12 (2.8)|
|Arthralgia||22 (2.7)||4 (2.0)||9 (2.1)|
|Diarrhea||13 (1.6)||3 (1.5)||4 (0.9)|
|Gastroenteritisf||11 (1.3)||4 (2.0)||4 (0.9)|
|Herpes simplex infectionsh||9(1.1)||0||2 (0.5)|
|a Subjects receiving 100 mg of TREMFYA at Week 0, Week 4, and every 8 weeks thereafter|
b U.S. licensed adalimumab
c Upper respiratory infections include nasopharyngitis, upper respiratory tract infection (URTI), pharyngitis, and viral URTI.
d Headache includes headache and tension headache.
e Injection site reactions include injection site erythema, bruising, hematoma, hemorrhage, swelling, edema, pruritus, pain, discoloration, induration, inflammation, and urticaria.
f Gastroenteritis includes gastroenteritis and viral gastroenteritis.
g Tinea infections include tinea pedis, tinea cruris, tinea infection, and tinea manuum infections.
h Herpes simplex infections include oral herpes, herpes simplex, genital herpes, genital herpes simplex, and nasal herpes simplex.
Adverse reactions that occurred in < 1% but > 0.1% of subjects in the TREMFYA group and at a higher rate than in the placebo group through Week 16 in PsO1 and PsO2 were migraine, candida infections, and urticaria.
Specific Adverse Reactions
Infections occurred in 23% of subjects in the TREMFYA group compared to 21% of subjects in the placebo group.
The most common (≥ 1%) infections were upper respiratory infections, gastroenteritis, tinea infections, and herpes simplex infections; all cases were mild to moderate in severity and did not lead to discontinuation of TREMFYA.
Elevated Liver Enzymes
Elevated liver enzymes were reported more frequently in the TREMFYA group (2.6%) than in the placebo group (1.9%). Of the 21 subjects who were reported to have elevated liver enzymes in the TREMFYA group, all events except one were mild to moderate in severity and none of the events led to discontinuation of TREMFYA.
Safety Through Week 48
Through Week 48, no new adverse reactions were identified with TREMFYA use and the frequency of the adverse reactions was similar to the safety profile observed during the first 16 weeks of treatment.
TREMFYA was studied in two placebo-controlled trials in subjects with psoriatic arthritis (748 subjects on TREMFYA and 372 subjects on placebo). Of the 748 subjects who received TREMFYA, 375 subjects received TREMFYA 100 mg at Week 0, Week 4, and every 8 weeks thereafter and 373 subjects received TREMFYA 100 mg every 4 weeks. The overall safety profile observed in subjects with psoriatic arthritis treated with TREMFYA is generally consistent with the safety profile in subjects with plaque psoriasis with the addition of bronchitis and neutrophil count decreased. In the 24-week placebo-controlled period, combined across the two studies, bronchitis occurred in 1.6% of subjects in the TREMFYA q8w group and 2.9% of subjects in the TREMFYA q4w group compared to 1.1% of subjects in the placebo group. Neutrophil count decreased occurred in 0.3% of subjects in the TREMFYA q8w and 1.6% of subjects in the TREMFYA q4w group compared to 0% of subjects in the placebo group. The majority of events of neutrophil count decreased were mild, transient, not associated with infection and did not lead to discontinuation.
As with all therapeutic proteins, there is the potential for immunogenicity with TREMFYA. The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of incidence of antibodies to guselkumab across indications or with the incidences of antibodies to other products may be misleading.
Up to Week 52, approximately 6% of subjects treated with TREMFYA developed antidrug antibodies. Of the subjects who developed antidrug antibodies, approximately 7% had antibodies that were classified as neutralizing antibodies. Among the 46 subjects who developed antibodies to guselkumab and had evaluable data, 21 subjects exhibited lower trough levels of guselkumab, including one subject who experienced loss of efficacy after developing high antibody titers. Up to Week 156, approximately 9% of subjects treated with TREMFYA developed antidrug antibodies and of these subjects approximately 6% were classified as neutralizing antibodies. However, antibodies to guselkumab were generally not associated with changes in clinical response or development of injection-site reactions.
Up to Week 24, 2% (n=15) of subjects treated with TREMFYA developed antidrug antibodies. Of these subjects, 1 had antibodies that were classified as neutralizing antibodies. Overall, the small number of subjects who were positive for antibodies to guselkumab limits definitive conclusion of the effect of immunogenicity on the pharmacokinetics, efficacy and safety of guselkumab.
The following adverse reactions have been reported during post-approval of TREMFYA. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to TREMFYA exposure.
Immune system disorders: Hypersensitivity, including anaphylaxis [see WARNINGS AND PRECAUTIONS]
Skin and subcutaneous tissue disorders: Rash [see WARNINGS AND PRECAUTIONS]
Read the entire FDA prescribing information for Tremfya (Guselkumab for Injection)