Biologics in the treatment of pustular psoriasis

Expert Opin Drug Saf. 2020 Aug;19(8):969-980. doi: 10.1080/14740338.2020.1785427. Epub 2020 Jul 2.

Abstract

Introduction: Pustular psoriasis is a group of skin diseases characterized by neutrophil infiltration in the epidermis and formation of sterile pustules. Conventional treatments, such as retinoids and immunosuppressive drugs, have improved the clinical manifestations; however, many patients suffer from drug-related toxicity or are resistant to therapy.

Areas covered: In this review, the authors focus on the efficacy and safety of these biologics, including anti-IL-1β (gevokizumab and canakinumab), anti-IL-1 R (anakinra), anti-IL-36 R (BI 655130), anti-tumor necrosis factor-α (etanercept, infliximab, and adalimumab), anti-IL-12/23 (ustekinumab), anti-IL-17A (secukinumab and ixekizumab), anti-IL-17RA (brodalumab), anti-IL-2 R (basiliximab), anti-IL-6 R (tocilizumab), and anti-IL-23 (risankizumab and guselkumab), for treating pustular psoriasis.

Expert opinion: Patients with pustular psoriasis treated with biologics demonstrated positive responses. Anti-TNF-α is the most available biologics for the treatment of pustular psoriasis, and anti-IL-12/23 and anti-IL-17A might be considered as the first- or second-line therapy for moderate-to-severe and refractory pustular psoriasis. Anti-IL-17A can be used in the pustular psoriasis patients who failed to respond to anti-TNF agents and anti-IL-12/23. Therapeutic efficacy of biologics in pustular psoriasis might have no association with IL-36 RN mutation status.

Keywords: Biologics; IL-36RN; acrodermatitis continua of Hallopeau; pustular psoriasis.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal / pharmacology
  • Biological Products / administration & dosage*
  • Biological Products / adverse effects
  • Biological Products / pharmacology
  • Dermatologic Agents / administration & dosage*
  • Dermatologic Agents / adverse effects
  • Dermatologic Agents / pharmacology
  • Humans
  • Psoriasis / drug therapy*
  • Psoriasis / pathology
  • Severity of Illness Index

Substances

  • Antibodies, Monoclonal
  • Biological Products
  • Dermatologic Agents