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Case study: Spesolimab for the treatment of generalized pustular psoriasis after ineffective response to ixekizumab
By Ella Dixon
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GPP is a rare, severe type of psoriasis that can cause recurrent erythema, pustules, and systemic inflammation. Li et al. published the case of a 52-year-old female with recurrent GPP for 2 years in Anais Brasileiros de Dermatologia. Symptoms included widespread erythema, sterile pustules, pain, generalized fatigue, and limb swelling. After discontinuing oral medications, symptoms were exacerbated. Previous treatments included oral acitretin, prednisone, and ixekizumab for 12 weeks, which proved ineffective. The IL-36 receptor inhibitor spesolimab was administered, with outcomes summarized here. |
| Key learnings |
| On admission, findings included diffuse erythema, numerous pustules, tenderness, elevated skin temperature, severe disease scores (GPPGA: 11; GPPASI: 38.3), and laboratory abnormalities (elevated WBC count, neutrophils, CRP, and decreased albumin). Skin biopsy confirmed a diagnosis of GPP. |
| Spesolimab was administered as a single 900 mg IV dose over 90 minutes after pre-biologic screening. Within 24 hours, pustules cleared almost entirely, and erythema began resolving (GPPGA: 5; GPPASI: 11.7). |
| After 5 days, minimal desquamation and no new lesions were observed (GPPGA: 2; GPPASI: 5) and laboratory values normalized. The patient maintained remission with topical corticosteroids at 3-month follow-up. |
| In this case study, spesolimab effectively managed acute GPP when conventional treatments failed. This highlights the role of the IL-36 pathway in GPP pathogenesis and suggests that spesolimab can be an effective option for refractory cases. |
Abbreviations: CRP, C-reactive protein; GPP, generalized pustular psoriasis; GPPASI, Generalized Pustular Psoriasis Area and Severity Index; GPPGA, Generalized Pustular Psoriasis Physician Global Assessment; IL, interleukin; IV, intravenous; WBC, white blood cell.
- Li W, Cui F, Zhang L, et al. Rapid improvement in a recurrent generalized pustular psoriasis patient ineffective to ixekizumab following spesolimab therapy. An Bras Dermatol. Online ahead of print. DOI: 10.1016/j.abd.2024.09.003
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