Introduction: Generalized pustular psoriasis (GPP) is a severe, life-threatening disease with a particularly high burden in Asian populations. However, real-world evidence on the effectiveness of biologic therapies remains limited, especially in resource-limited settings.
Objectives: To describe the clinical profiles, treatment patterns and outcomes, and assess the impact of therapies on disease recurrence in GPP inpatients.
Methods: This retrospective cohort study analyzed hospitalized patients with GPP treated at a tertiary referral center in China between March 2017 and February 2024. Patients were reassessed according to Asia-Pacific consensus criteria.
Results: A total of 322 inpatients with moderate-severe GPP were included, recording 419 hospitalizations. There were 212 GPP with psoriasis vulgaris (GPP+PV) and 110 GPP-PV patients, showing differences in clinical characteristics, including comorbidities. Over the 7-year study period, biologic utilization increased from 0 to 57.0%, while total annual hospitalizations decreased by 38.9%. Patients receiving biologics monotherapy demonstrated significantly better outcomes than those receiving traditional therapies, including shorter mean hospitalization duration (6.1 ± 3.4 vs. 9.2 ± 3.3 days, p < 0.001), faster pustule clearance (4.2 ± 2.6 vs. 6.8 ± 3.0 days, p = 0.001), and significantly lower recurrence rates. Multivariate analysis demonstrated, for the first time, the independent treatment effect of biologic-targeted therapy. Survival analysis confirmed significantly shorter median time to achieve GPPGA 0/1 (6 vs. 9 days, log-rank p < 0.001) and complete pustule clearance (5 vs. 11 days, log-rank p < 0.001) with biologics. Among all follow-up patients, the recurrence rate dropped from 51.7% to 29.3%, with only biologics significantly reducing flare frequency at post-discharge compared with pre-discharge (0.6 ± 0.3 vs. 1.4 ± 0.9 flares/person-year, p = 0.016).
Conclusion: These findings provide robust real-world evidence that biologics significantly improve both acute and long-term outcomes in GPP, supporting their use as first-line therapy and underscoring the need to improve global access to these treatments.
Keywords: Generalized pustular psoriasis; biologic; effectiveness; outcome; real-world evidence; recurrence; treatment pattern.