Use of Biological Therapies for the Management of Pustular Psoriasis: A New Era?

Megna, Matteo; Camela, Elisa; Ruggiero, Angelo; Battista, Teresa; Fabbrocini, Gabriella; Cacciapuoti, Sara; Potestio, Luca

doi:10.2147/ccid.s407812

Cited by 19 publications

(9 citation statements)

References 147 publications

(265 reference statements)

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“…Current treatment of GPP flares often relies on the off-label use of medications licensed for moderate to severe plaque psoriasis, but the limited evidence that supports this practice is derived from case reports and small single-arm studies [ 9 , 14 , 20 ]. Actually, while it can co-exist with plaque psoriasis and is traditionally classified as a subtype of psoriasis, GPP stands apart due to its distinctive clinical and immune-histopathologic features, as well as genetics [ 1 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, established international guidelines for the pharmacologic treatment of GPP are lacking, mainly due to the scarcity of high-quality evidence data on its efficacy. The management of GPP has been globally based on recommendations designed for plaque psoriasis [ 14 , 19 , 20 ]. In fact, before spesolimab approval in 2022, no specific treatments for GPP were approved by the FDA or EMA.…”

Section: Overview Of Current Treatment Options In Generalized Pustula...mentioning

confidence: 99%

“…Furthermore, various biologic agents approved for moderate to severe plaque psoriasis, such as TNF inhibitors (infliximab, adalimumab, certolizumab), IL-12/23 and IL-23 inhibitors (ustekinumab, guselkumab and risankizumab) and IL-17 inhibitors (brodalumab, secukinumab, ixekizumab) have emerged as potential options for the treatment of GPP, with several being licensed in Japan, as well as brodalumab in Taiwan and Thailand. These agents have also been frequently used off-label to treat GPP flares in other countries, although evidence supporting its efficacy is mainly derived from case series and small open-label, single-arm trials [ 9 , 13 , 14 , 20 – 23 ]. There are also case reports of GPP exhibiting a positive response to IL-1 inhibition with anakinra, canakinumab and gevokizumab [ 14 , 24 , 25 ].…”

Section: Overview Of Current Treatment Options In Generalized Pustula...mentioning

confidence: 99%

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Spesolimab for the Treatment of Generalized Pustular Psoriasis

Bernardo,

Thaçi,

Torres

2023

Drugs

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Generalized pustular psoriasis (GPP) is a rare but severe skin inflammatory disorder characterized by the eruption of widespread sterile neutrophilic pustules, often accompanied by systemic inflammation. Given its life-threatening potential, GPP requires prompt accurate diagnosis and effective treatment, but its rarity and relapsing-remitting nature pose challenges in performing large-scale randomized controlled clinical trials. Established international guidelines are currently lacking and management guidance often follows that for plaque psoriasis. However, while it can co-exist with plaque psoriasis and has traditionally been classified as a most severe form of psoriasis, GPP is now recognized as a distinct entity, with its own clinicopathological, autoinflammatory, immunologic and genetic features. Research conducted over the past decade revealed that an imbalance of interleukin (IL)-36 signaling favoring the proinflammatory activity is the central driver of the pathogenesis of GPP, thereby laying the groundwork for the development of targeted therapies for the disease. This article reviews the evidence thus far on spesolimab, a selective humanized antibody against the IL-36 receptor that was recently licensed in Europe and the United States for the treatment of GPP flares in adults. In phase II, randomized controlled clinical trials, spesolimab led to rapid and effective skin clearance in patients experiencing a GPP flare and demonstrated superiority to placebo in preventing flares for up to 48 weeks with maintenance treatment, with reassuring safety and tolerability profiles. Spesolimab is considered to be a first-in-class medication establishing itself as the standard of care for the treatment of GPP flares, thus changing the paradigm of the management of GPP to a new era of scientifically- and evidence-based targeted therapy for this distinctive disease.

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Section: Discussionmentioning

confidence: 99%

Section: Overview Of Current Treatment Options In Generalized Pustula...mentioning

confidence: 99%

Section: Overview Of Current Treatment Options In Generalized Pustula...mentioning

confidence: 99%

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Spesolimab for the Treatment of Generalized Pustular Psoriasis

Bernardo,

Thaçi,

Torres

2023

Drugs

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“… 1 , 3 Other phenotypes include guttate, erythrodermic, pustular, inverse, and palmoplantar psoriasis. 1 , 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

The Role of Interleukin 23/17 Axis in Psoriasis Management: A Comprehensive Review of Clinical Trials

Potestio,

Martora,

Lauletta

et al. 2024

CCID

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Psoriasis pathogenesis is influenced by genetic factors and characterized by a complex interplay between genetic predisposition and various environmental triggers. These triggers set off metabolic processes involving inflammation, cell signaling, immune response dysregulation, and antigen presentation. Several types of innate and adaptive immune cells are involved in psoriasis. Among the cytokine cascade which leads to psoriasis development, the interleukin (IL)-23/Th17 axis, especially IL-17 production, emerges as crucial. Recognizing the pivotal role of this axis has facilitated the development of selective and effective biological drugs, such as anti-IL17 and anti-IL23 monoclonal antibodies. These drugs aim to achieve the complete or near-complete disappearance of psoriatic lesions, as indicated by PASI100 and PASI90 responses, respectively. In this context, the aim of our review was to delve into the functioning of the IL-23/Th17 axis, its dysregulation in psoriasis pathogenesis, and the therapeutic potential of its inhibition. Currently, 4 anti-IL17 (secukinumab, ixekizumab, bimekizumab and brodalumab) and 3 anti-IL23 (guselkumab, risankizumab and tildrakizumab) have been approved. All these drugs showed high levels of effectiveness in both clinical trials and real-life experiences, with an excellent profile in terms of safety. Certainly, furthers studies will allow for better characterization of biologics’ profile, in order to administer the right drug for the right patients at the right moment.

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“…1 The release of cytokines such as IL-17 and TNF-alpha cause the activation of neutrophils, Th17 cells, and dendritic cells, leading to neutrophilic infiltration. 4 Additionally, the IL-36 inhibitor spesolimab, which recently received FDA approval for GPP management, could be considered. The IL-36 axis drives the release of these cytokines and plays a central role in stimulating pustular formation.…”

mentioning

confidence: 99%

Elderly Onset Generalized Pustular Psoriasis: A Systematic Review

Shergill,

McAdam,

Tarafdar

et al. 2023

J Cutan Med Surg

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Use of Biological Therapies for the Management of Pustular Psoriasis: A New Era?

Cited by 19 publications

References 147 publications

Spesolimab for the Treatment of Generalized Pustular Psoriasis

Spesolimab for the Treatment of Generalized Pustular Psoriasis

The Role of Interleukin 23/17 Axis in Psoriasis Management: A Comprehensive Review of Clinical Trials

Elderly Onset Generalized Pustular Psoriasis: A Systematic Review

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