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We evaluated the effect of guselkumab on fatigue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Across two phase 3 trials of guselkumab (DISCOVER-1, DISCOVER-2), patients with active PsA despite standard therapy were randomized to subcutaneous injections of guselkumab 100\u2009mg every 4\u2009weeks (Q4W,<jats:italic>N<\/jats:italic>= 373); guselkumab 100\u2009mg at week 0, week 4, and then Q8W (<jats:italic>N<\/jats:italic>= 375); or placebo (<jats:italic>N<\/jats:italic>= 372) through week 24, after which patients in the placebo group crossed over to guselkumab Q4W. Fatigue was measured as a secondary endpoint using the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue instrument (range 0\u201352, higher scores indicate less fatigue). Least-squares mean changes in FACIT-Fatigue scores were compared between treatments using a mixed-effect model for repeated measures. Mediation analysis was used to adjust for indirect effects on fatigue deriving from improvement in other outcomes, including \u226520% improvement in American College of Rheumatology criteria (ACR20; prespecified), minimal disease activity (MDA; post hoc), or C-reactive protein (CRP; post hoc).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline mean (SD) FACIT-Fatigue scores in DISCOVER-1 (<jats:italic>N<\/jats:italic>= 381) and DISCOVER-2 (<jats:italic>N<\/jats:italic>= 739), ranging from 29.1 (9.5) to 31.4 (10.1), indicated substantial levels of fatigue relative to the United States general population (43.6 [9.4]). Across studies, mean improvements, and proportions of patients with \u22654-point improvements, in FACIT-Fatigue scores at week 24 with guselkumab Q4W and Q8W (5.6\u20137.6 and 54\u201363%, respectively) were larger vs placebo (2.2\u20133.6 and 35\u201346%). Improvement in FACIT-Fatigue scores with guselkumab was sustained from week 24 to week 52, with moderate-to-large effect sizes (Cohen\u2019s<jats:italic>d<\/jats:italic>= 0.52\u20130.81 at week 24; 0.66\u20130.91 at week 52). Mediation analyses demonstrated that substantial proportions of the effects of guselkumab vs placebo on fatigue were direct effect, after adjusting for achievement of ACR20 (Q4W 69\u201370%, Q8W 12\u201336% direct effect) or MDA (72\u201392% across dosing regimens) response or for change in serum CRP concentrations (82\u201388% across dosing regimens).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with active PsA, guselkumab 100\u2009mg Q4W or Q8W led to clinically meaningful and sustained improvements in fatigue through 1\u2009year. A substantial portion of the improvement in FACIT-Fatigue scores induced by guselkumab was independent of effects on the achievement of other select outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration<\/jats:title><jats:p>Name of the registry: ClinicalTrials.gov<\/jats:p><jats:p>Trial registrations: DISCOVER-1, NCT03162796; DISCOVER-2, NCT03158285<\/jats:p><jats:p>Date of registration: DISCOVER-1, May 22, 2017; DISCOVER-2, May 18, 2017<\/jats:p><jats:p>URLs of the trial registry record:<\/jats:p><jats:p>DISCOVER-1,<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03162796?term=NCT03162796&amp;draw=1&amp;rank=1\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03162796?term=NCT03162796&amp;draw=1&amp;rank=1<\/jats:ext-link><\/jats:p><jats:p>DISCOVER-2,<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03158285?term=NCT03158285&amp;draw=2&amp;rank=1\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03158285?term=NCT03158285&amp;draw=2&amp;rank=1<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1186\/s13075-021-02554-3","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T06:02:37Z","timestamp":1626242557000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Guselkumab demonstrated an independent treatment effect in reducing fatigue after adjustment for clinical response\u2014results from two phase 3 clinical trials of 1120 patients with active psoriatic arthritis"],"prefix":"10.1186","volume":"23","author":[{"given":"Proton","family":"Rahman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip J.","family":"Mease","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip S.","family":"Helliwell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atul","family":"Deodhar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laure","family":"Gossec","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur","family":"Kavanaugh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexa P.","family":"Kollmeier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth C.","family":"Hsia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bei","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiwu","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"May","family":"Shawi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chetan S.","family":"Karyekar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7175-7834","authenticated-orcid":false,"given":"Chenglong","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,7,14]]},"reference":[{"issue":"10","key":"2554_CR1","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1056\/NEJMra1505557","volume":"376","author":"CT Ritchlin","year":"2017","unstructured":"Ritchlin CT, Colbert RA, Gladman DD. 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The protocols were approved by Institutional Review Boards. All patients gave written informed consent before any study-related procedures were performed.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"PR has received research support (Janssen, Novartis), consulting fees (AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB), and speakers bureau support (AbbVie, Janssen, Eli Lilly, Novartis, Pfizer, and UCB). PJM has received research support, consulting fees (AbbVie, Amgen, Bristol Myers Squibb, Galapagos, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, SUN, and UCB) and consulting fees (Boehringer Ingelheim and GlaxoSmithKline). PSH has received research support and non-financial support (AbbVie), research support (Janssen, Pfizer), and consulting fees (Janssen, Galapagos, and Novartis). AD has received research support (AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, and UCB), consulting fees (AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, GlaxoSmithKline, Janssen, Novartis, Pfizer, and UCB), and speakers bureau support (AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB). LG has received research grants (Amgen, Galapagos, Janssen, Eli Lilly, Pfizer, Sandoz, and Sanofi) and consulting fees (AbbVie, Amgen, Bristol Myers Squibb, Biogen, Celgene, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, and UCB). AK has received research support and\/or consulting fees (AbbVie, Amgen, Bristol Myers Squibb, Genentech, Janssen, Eli Lilly, Merck, Novartis, Pfizer, and UCB). APK, ECH, BZ, XL, MS, CSK, and CH are employed by subsidiaries of, and own stock in, Johnson & Johnson.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"190"}}