Biologics in the treatment of pustular psoriasis

Abstract

Introduction: Pustular psoriasis is a group of skin diseases characterized by neutrophil infiltration in the epidermis and formation of sterile pustules. Conventional treatments, such as retinoids and immunosuppressive drugs, have improved the clinical manifestations; however, many patients suffer from drugrelated toxicity or are resistant to therapy. Areas covered: In this review, the authors focus on the efficacy and safety of these biologics, including anti-IL-1β (gevokizumab and canakinumab), anti-IL-1 R (anakinra), anti-IL-36 R (BI 655130), anti-tumor necrosis factor-α (etanercept, infliximab, and adalimumab), anti-IL-12/23 (ustekinumab), anti-IL-17A (secukinumab and ixekizumab), anti-IL-17RA (brodalumab), anti-IL-2 R (basiliximab), anti-IL-6 R (tocilizumab), and anti-IL-23 (risankizumab and guselkumab), for treating pustular psoriasis. Expert opinion: Patients with pustular psoriasis treated with biologics demonstrated positive responses. Anti-TNF-α is the most available biologics for the treatment of pustular psoriasis, and anti-IL-12/23 and anti-IL-17A might be considered as the first-or second-line therapy for moderate-to-severe and refractory pustular psoriasis. Anti-IL-17A can be used in the pustular psoriasis patients who failed to respond to anti-TNF agents and anti-IL-12/23. Therapeutic efficacy of biologics in pustular psoriasis might have no association with IL-36 RN mutation status.

Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options

“…There remains a need for an effective treatment with a rapid onset of action, and for robust clinical trial data to guide treatment decisions. Newer treatments for GPP are emerging, including IL-17 inhibitors, which have been approved for the treatment of GPP in Japan (IL-17A monoclonal antibodies: brodalumab, ixekizumab, and secukinumab) [48,68]. Other approved agents for GPP in Japan are IL-23 agents, guselkumab and risankizumab, and TNFa agents, infliximab and adalimumab [48,68].…”

Characteristics of hospitalizations and emergency department visits due to generalized pustular psoriasis in the United States

“…Other therapies include adalimumab, etanercept, and combination of a systemic agent such as acitretin, cyclosporine, methotrexate, or apremilast and a biologic [10][11][12] . In addition to these treatment options, there is limited evidence to support the use of newer biologics for treatment of GPP, including interleukin 17 (IL-17) and IL-23 targeted monoclonal antibodies, though their efficacy and safety have not been studied in randomized controlled trials involving GPP patients 1,10,13,14 . Treatment response can vary due to the persistence of lesions, recurrence of flares, and the limited availability of clinical data about plaque psoriasis products highlighting unmet treatment need for GPP patients 4,15 .…”

Psoriasis: Recent progress in molecular‐targeted therapies

“…138,194 Spesolimab is a humanized monoclonal antibody against IL-36 receptor. 143 In a phase 1 proof-of-concept study on seven GPP cases, a single intravenous administration of spesolimab (10 mg/kg) significantly reduced the GPP severity score and maintained the status up to week 20. based on the biochemical functions and homologies. [145][146][147] In particular, the PDE-4 family works specifically on cAMP degradation and is expressed in the brain, cardiac muscle, smooth muscles, keratinocytes, and immunocytes such as T lymphocytes, monocytes, macrophages, neutrophils, DCs, and eosinophils.…”

“…Spesolimab is a humanized monoclonal antibody against IL‐36 receptor 143 . In a phase 1 proof‐of‐concept study on seven GPP cases, a single intravenous administration of spesolimab (10 mg/kg) significantly reduced the GPP severity score and maintained the status up to week 20 144 …”