Generalized pustular psoriasis (GPP) is a rare, chronic, and severe inflammatory skin disorder characterized by sudden eruption of sterile pustules, often accompanied by systemic inflammation. GPP flares can be life-threatening if untreated, owing to potential serious complications such as sepsis and cardiovascular failure. Diagnosis and clinical measurement of disease severity in GPP are often difficult. Lack of standardized criteria in the international guidelines and the heterogeneity of cutaneous and extracutaneous symptoms make the diagnosis of GPP difficult. Clinical criteria for description and diagnosis of pustular conditions, including GPP, are variable and there is no specific agreement on commonly sustained concepts. Differentiation of GPP from other similar conditions/diseases is important and requires careful assessments. The evidence that supports current topical or systemic therapies is largely based on case reports and small studies. Some biologic agents that target key cytokines involved in the activation of inflammatory pathways have been used as treatments for GPP. Recently, spesolimab, an IL-36R antagonist, has been approved in the USA and Japan for the treatment of GPP flares in adults, but there are no currently approved treatments for GPP in Europe. The IL-36 pathway has recently emerged as a central axis driving the pathogenic inflammatory mechanisms of GPP. Biologic agents that inhibit the IL-36 pathway have shown efficacy and safety in patients with GPP, addressing a generally considered unmet medical need.

Background: Biologic treatments have been studied mainly in patients with a long‐term history of psoriasis and previous treatment failures.Objectives: The purpose of this primary analysis of the STEPIn study is to determine whether early intervention with secukinumab in patients with new‐onset moderate to severe plaque psoriasis is superior to standard of care treatment with narrow band ultraviolet B (nb‐UVB) phototherapy.Methods: The STEPIn study is a randomized, open‐label, multicentre study to investigate early intervention with 52 weeks of secukinumab 300 mg administered subcutaneously versus standard treatment with nb‐UVB phototherapy in patients with new‐onset (≤12 months) moderate to severe plaque psoriasis (NCT03020199). The primary and additional secondary endpoints were ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) at Week 52 and Investigator's Global Assessment (IGA mod 2011) 0/1 response at Week 52, respectively.Results: In the secukinumab and nb‐UVB study arms, 77/80 and 76/80 randomized patients received at least one dose of study treatment, respectively. The primary endpoint was achieved: 91.1% (70/77) of patients achieved a PASI 90 response at Week 52 in the secukinumab arm versus 42.3% (32/76) in the nb‐UVB arm (p < 0.0001, odds ratio [OR] estimate [95% confidence intervals, CI] = 16.3 [5.6, 46.9]). The additional secondary endpoint was also achieved: 85.7% of patients achieved an IGA 0/1 response at Week 52 in the secukinumab arm versus 36.8% in the nb‐UVB arm (p < 0.0001). The safety data were consistent with the safety profiles of secukinumab and nb‐UVB with no new or unexpected safety signals.Conclusions: Secukinumab was superior to nb‐UVB in treating patients with new‐onset moderate to severe plaque psoriasis. The high and sustained skin clearance observed indicates that biologic treatment for psoriasis may be more effective if used early in the disease course.

Background: Tildrakizumab (TIL) is an interleukin (IL)‐23p19 inhibitor for the treatment of moderate‐to‐severe plaque psoriasis with long‐term efficacy and safety demonstrated in Phase III trials. Studies conducted in conditions closer to clinical practice are needed.Objectives: The TRIBUTE study (open‐label, Phase IV) assessed the efficacy and impact on health‐related quality of life (HRQoL) of TIL 100 mg in adult moderate‐to‐severe psoriasis patients (naïve to IL‐23/Th17 pathway inhibitors) in conditions similar to clinical practice.Methods: Key efficacy measure was Psoriasis Area Severity Index (PASI). HRQoL was evaluated using the Dermatology Life Quality Index (DLQI) and Skindex‐16. Additional patient‐reported outcomes included Pain‐, Pruritus‐ and Scaling‐Numerical Rating Scale (NRS), Medical Outcome Study (MOS)‐Sleep, Work Productivity and Activity Impairment (WPAI), Patient Benefit Index (PBI) and Treatment Satisfaction Questionnaire for Medication (TSQM).Results: One hundred and seventy‐seven patients were enrolled (six patients did not complete the study). After 24 weeks, the proportion of patients achieving PASI scores ≤ 3, PASI 75, PASI 90 and DLQI 0/1 was 88.4%, 92.5%, 74.0% and 70.4%, respectively. Skindex‐16 overall score improved (mean absolute change from baseline, MACB [95%CI]: −53.3 [−58.1, −48.5]). Significant benefits (MACB [95%CI]) were found on pruritus‐, pain‐ and scaling‐NRS scores (−5.7 [−6.1, −5.2], −3.5 [−4.1, −3.0] and −5.7 [−6.2, −5.2], respectively), MOS‐Sleep (−10.4 [−13.3, −7.4] Sleep problems Index II) and WPAI (−36.4 [−42.6, −30.2] activity impairment, −28.2 [−34.7, −21.7] productivity loss, −27.0 [−32.9, −21.1] presenteeism and −6.8 [−12.1, −1.5] absenteeism). 82.7% of patients reported PBI ≥ 3 and the mean (SD) global TSQM score was high (80.5 [18.5]). Only one serious treatment‐emergent adverse event was reported (not‐related to TIL).Conclusions: TIL 100 mg treatment after 24 weeks in conditions close to real clinical practice showed a quick and high improvement in psoriasis signs and HRQoL. Patient reported improvements in sleep outcomes and work productivity, relevant benefits and high treatment satisfaction. The safety profile was favourable and consistent with Phase III trials.

Background Data on the effectiveness and safety of a drug in real-world clinical practice complement the evidence from clinical trials, which are carried out in a different setting. Little has been published on the effectiveness and safety of guselkumab in the treatment of psoriasis in clinical practice. Objectives To assess the effectiveness and safety of guselkumab at 24 weeks in patients with moderate to severe plaque psoriasis in routine clinical practice. Methods Retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis treated with guselkumab for at least 24 weeks in Spain. Results We studied 343 patients, 249 of whom were followed for 24 weeks. By week 24, the mean (SD) Psoriasis Area and Severity Index (PASI) had decreased from 11.1 (7.3) to 1.7 (2.8) (-9.3; [-10.2;-8.4]), 85.9% of the patients had achieved PASI score of 4 or less and 77.9% a PASI score of 2 or less. In terms of relative PASI response, 59.4% of the patients achieved a PASI-90 response and 49.0% a PASI-100 response. On multivariate analysis, 2 factors reduced the probability of a PASI of 2 or less at 24 weeks: a BMI ≥30 (OR, 0.44; 95% CI, 0.22-0.88) and a greater previous exposure to biologic therapy (OR, 0.69; 95% CI, 0.56-0.84]). Adverse events were rare (9.9%) and led to withdrawal from treatment in only 9 patients (2.6%) by the end of the follow-up period. Conclusion The results of this study confirm the high efficacy and safety of guselkumab indicated by the clinical trial data. In clinical practice, the absolute PASI score appears to be a better marker of response to treatment than the relative value.

La artritis psoriásica (APs) es una forma común de artritis inflamatoria que aparece hasta en el 40% de los pacientes con psoriasis. Dado que la afectación cutánea suele preceder a la afectación articular, los dermatólogos desempeñan un papel fundamental en la detección precoz de la APs. El diagnóstico precoz es importante para reducir el riesgo de daños estructurales irreversibles, limitar el deterioro de la función física y mejorar la calidad de vida de los pacientes. El presente documento ha sido elaborado por un grupo de especialistas (nueve dermatólogos y un reumatólogo) con el objetivo de proporcionar recomendaciones sencillas que ayuden a los dermatólogos en el cribado de la APs en pacientes con psoriasis. Los expertos elaboraron el presente documento ofreciendo unas recomendaciones consensuadas basadas en una revisión descriptiva de la evidencia científica disponible y en la experiencia adquirida en la práctica clínica diaria.