Treatment with spesolimab in patients with generalized pustular psoriasis: A review of real-world experience

Abstract Generalized pustular psoriasis (GPP) is a potentially life-threatening infrequent immune-mediated disease characterized by rapid-onset of erythematous plaques, sterile pustules, and systemic inflammation. Spesolimab, a monoclonal antibody targeting the interleukin-36 receptor, is a novel treatment for GPP. However, GPP’s low incidence and limited evidence represents a challenge in determining its real-world efficacy. This review aims to explore the clinical use of spesolimab in a real-world setting. We conducted a review on PubMed, SCOPUS, EMBASE, and ScienceDirect of case series and reports of patients with GPP treated with spesolimab. Review articles and clinical trials were excluded. A total of 62 patients with GPP were included. Age ranged from 4 to 88 years. A total of 48 reported comorbidities of which 30 patients had plaque psoriasis. Spesolimab 900 mg IV was administered in 1 to 4 doses. Follow-up periods ranged from 2 weeks to 15 months. Complete GPP remission was observed in 35 (56.4%, 35/62) patients, 21 of them achieving it within a week. Partial remission was defined in 27 (43.5%) patients. GPP recurrence after treatment was observed in seven patients. After spesolimab administration, plaque psoriasis recurrence was reported in six (20%, 6/30) patients, three (10%, 3/30) reported improvement, and 21 (70%, 21/30) didn't report information about their outcome. Eight patients reported adverse effects including laboratory abnormalities, infections, and erythema multiforme. Spesolimab demonstrates a low prevalence of adverse events and clinical efficacy for GPP treatment including patients with comorbidities, infections, and over 75 years of age. Its effect on plaque psoriasis remains unclear.