Secukinumab Improved HRQOL, Symptoms in Pediatric Generalized Pustular Psoriasis

A recently published case series examined the real-world data of secukinumab when used for pediatric generalized pustular psoriasis (GPP).

Secukinumab is known to be effective in adults with GPP, but the long-term efficacy and safety in children with this rare disease is unknown.

The authors, writing in a letter to the editor in the Journal of the American Academy of Dermatology, described 18 patients, seen in China’s First Affiliated Hospital of Fujian Medical University, who received secukinumab from July 2019 to August 2020 and were followed for 48 weeks.

Most patients were male, with a mean age (SD) of 7.9 (2.3) years with a mean bodyweight of 29.3 (10.9) kg.

Of the 18 patients:

• 12 had plaque psoriasis before developing GPP
• The mean duration of their GPP was 3.3 years
• Their mean Generalized Pustular Psoriasis Area and Severity Index (GPPASI) score at baseline was 31.7
• Most patients had a mean Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) score at baseline of 3 or 4

Participants received secukinumab 75 mg only via subcutaneous administration at weeks 0, 1, 2, 3, 4 and then every 4 weeks.

Primary outcomes included changes in body temperature, laboratory examination assessments, and the changes in scores of the GPPASI and GPPGA from baseline.

Secondary outcomes included health-related quality of life (HRQOL), assessed by the Children's Dermatology Life Quality Index (CDLQI) and the Pediatric Quality of Life Inventory (PedsQL) scale.

In week 1, there was a rapid drop in body temperature and a reduction in white blood cell count and C-reactive protein.

In week 2, serum albumin levels improved from 36.3 (5.1) at baseline to 44.8 (1.9) at week and to 46.2 (3.8) at week 4.

Pustules subsided rapidly within 3 days of seckinumab treatment and erythema and scale reduced gradually in 2 weeks.

Also in week 2, mean GPPASI score fell from 31.7 to 5.1, and fell further to 1.3 at week 4. The improvement continued to week 48.

At week 48, 13 patients (72%) achieved GPPASI 100 while the other 5 patients achieved GPPASI 90. The GPPGA total score and the GPPGA pustulation subscore fell over time.

Side effects, which included eczema-like reactions, were mild. There were no serious adverse events.

For secondary outcomes, the investigators used the CDLQI and the PedsQL scales.

At the 48-week follow-up, results showed secukinumab improved HRQOL. The mean CDLQI score at baseline was 13.6 (5.5) and by week 48, 100% of the participants had a CDLQI score of 0 or 1. The reduction in the score was correlated with symptom improvement.

The PedsQL score was 25.5 (7.3) at baseline and began improving as early as week 2.

“Taken together, for pediatric GPP patients, the systemic inflammation and skin symptoms did rapidly improve with the treatment of secukinumab, and this effect was maintained up to 48 weeks without any unexpected safety signal,” the authors concluded. “These findings suggest that secukinumab can be a promising therapeutic option for pediatric GPP.”

Reference

Ruan SF, Zhang Ll, Liu Z, et al. Real-world data on the clinical use of secukinumab in pediatric generalized pustular psoriasis: a 48-week retrospective study. J Am Acad Dermatol. Published online May 16, 2022. doi:10.1016/j.jaad.2022.04.064.