Biologics best other treatments in morbidity, mortality in generalized pustular psoriasis

Biologic therapies demonstrated improved morbidity and mortality outcomes compared with oral agents and steroids in patients with generalized pustular psoriasis, according to a study.

“Because generalized pustular psoriasis (GPP) is uncommon, there are few studies reporting treatments and outcomes for large numbers of patients,” Hideaki Miyachi, MD, PhD, of the department of dermatology at the Graduate School of Medicine at Chiba University in Chiba, Japan, and colleagues wrote.

In the analysis of a national inpatient database in Japan, Miyachi and colleagues aimed to assess treatment paradigms and outcomes in 1,516 patients with GPP. Eligible participants had required hospitalization between July 2010 and March 2019.

The analysis included 294 patients treated with biologic therapies, 948 treated with oral agents without biologics and 274 treated with corticosteroids only.

The mean age of patients in the cohort was 66 years. ICU admissions were reported in 3.3% of patients, while 8.2% required blood pressure support. The mortality rate was 4.2%.

“Patients receiving biologics were younger and had fewer comorbidities and lower in-hospital mortality (1% [biologics group] vs. 3.7% [oral agents group] vs. 9.1% [corticosteroids-only group], P < .001),” according to the findings. Morbidity rates were 5.4% for the biologic group compared with 8.2% for oral agents and 12% for corticosteroids (P = .02).

Looking closer at trends in biologic use, treatment with interleukin (IL)-17 inhibitors increased over time. Moreover, IL-17 inhibitors were associated with comparable in-hospital mortality and morbidity outcomes as TNF inhibitors.

Rates of catecholamine and other vasopressor use were 7.5% for biologics and 7.2% for oral therapies compared with 13% for corticosteroids (P = .01). However, ICU admissions, central venous catheterization, mechanical ventilation use and continuous hemodiafiltration use were comparable across treatment arms.

The researchers noted two key limitations, including the retrospective design and the fact that some patients in the cohort were treated with more than one medication.

“Patients with GPP who were treated with biologics demonstrated favorable outcomes compared with other treatments,” the researchers wrote. “Our findings provide useful information for treatment decision-making for patients with GPP hospitalized in the biologics era.”