Generalised pustular psoriasis: IL-36 inhibits new flares up to week 48

IL-36 receptor antibody spesolimab improved erythema, pustulation, and scaling/crusting of skin lesions in generalised pustular psoriasis (GPP).

Proportion of participants with a GPPGA score of 0 increased after spesolimab

IL-36 plays a key role in GPP pathogenesis. The antibody spesolimab specifically targets the IL-36 receptor and is approved for the treatment of GPP flares. Previously, it has been evaluated for the prevention of flares in the randomised, placebo-controlled Effisayil 2 (NCT04399837) trial. At the meeting, Prof. Matthias Augustin (University Medical Center Hamburg-Eppendorf, Germany) presented an analysis of Effisayil 2, which assessed the effect of high-dose spesolimab (i.e. 600 mg loading dose followed by 300 mg every 4 weeks) or placebo on GPP lesions using both subscores and the total score of the GPP Physician Global Assessment (GPPGA) scale1.

GPPGA subscores for erythema, pustulation, and scaling/crusting as well as GPPGA total score were compared between participants receiving high-dose spesolimab and placebo. “Only 23% of participants had an IL36RN mutation,” Prof. Augustin explained.

After treatment initiation with spesolimab, the proportion of participants with a GPPGA score of 0 (0 for all 3 components erythema, pustulation, and scaling) increased, whereas the score remained similar in the placebo group at week 4. In addition, the proportion of participants with GPP flares was lower with high-dose spesolimab compared with placebo.

Moreover, the agent showed long-term efficacy in managing skin manifestations. A greater proportion of participants with a GPPGA total score of 0 was achieved and maintained with spesolimab compared with placebo over 48 weeks. The superiority of spesolimab was evident in each subscore compared with placebo up to week 48. Importantly, no new flares were observed with high-dose spesolimab after week 4.

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  1. Augustin M. Effect of high-dose subcutaneous spesolimab on skin manifestations: Results from the pivotal Effisayil 2 trial of flare prevention in generalized pustular psoriasis. FC05.2, EADV Congress 2023, 11–14 October, Berlin, Germany.