Drug survival in the treatment of generalized pustular psoriasis: A retrospective multicenter study. Issue 2 (15th February 2021)

• Record Type: Journal Article
• Authors: Kromer, Christian; Loewe, Emilia; Schaarschmidt, Marthe‐Lisa; Pinter, Andreas; Gerdes, Sascha; Herr, Raphael; Poortinga, Sietske; Moessner, Rotraut; Wilsmann‐Theis, Dagmar
• Is Part Of: Dermatologic therapy. Volume 34:Issue 2(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-02-15
• Subjects: GPP -- IL‐12/23 -- IL‐17 -- TNF‐alpha -- Zumbusch; Skin -- Diseases -- Periodicals; Dermatology -- Periodicals; 616.5
• DOI: 10.1111/dth.14814
• Languages: English
• ISSNs: 1396-0296

Abstract

Abstract: Generalized pustular psoriasis (GPP) is a rare, potentially life‐threatening inflammatory skin disease. Our aim was to assess patient and disease characteristics and analyze drug survival rates in the treatment of GPP in a real‐life setting. In this retrospective study, 201 treatment series of 86 patients with GPP treated at five University Medical Centers were analyzed. Overall, excellent response was reached in 41.3% of all treatment courses, partial response in 31.4%, and nonresponse in 27.3%. Biological treatment was significantly more effective than non‐biological therapies (excellent response: 47.4% vs 35.9%; P = .02). Overall, the median drug survival was 14.0 months (biologicals: 36.0 months vs nonbiologicals: 6.0 months; P < .001). The crude probability of survival was highest for secukinumab (hazard ratio [HR] of drug discontinuation compared with acitretin: 0.22), followed by ixekizumab and ustekinumab (HR: 0.38 each), adalimumab (HR: 0.59), etanercept (HR: 0.62), infliximab (HR: 0.69), cyclosporine (HR: 1.00), acitretin (reference for HR), fumaric acid esters (HR: 1.06), methotrexate (HR: 1.26), and apremilast (HR: 3.44); no drug discontinuation with guselkumab. Our results reveal high efficacy and drug survival, particularly for IL‐17 and IL‐(12)/23 antagonists. Thus, these biologics may be considered early in the therapeutic algorithm of GPP.