Early evidence indicates that biologic therapy is effective treatment for not only plaque psoriasis but also erythrodermic and generalized pustular psoriasis.
After conducting a literature review of studies that assessed the safety and efficacy of biologic medications on severe subtypes of psoriasis, Ethan C. Levin, MD, and colleagues then identified strategies to help clinicians optimally manage patients diagnosed with psoriasis.
The primary literature included cases reports, cases series, and open-label, uncontrolled trials, but the investigators found no head-to-head studies or other controlled trials.
Most patients reported improvement of symptoms with use of biologic therapy. Serious adverse events occurred in 10% to 12% of patients.
Infliximab (Remicade) was used to treat more than half of the reported cases of both erythrodermic and generalized pustular psoriasis, the researchers found. Additional biologic medications successfully used included etanercept (Enbrel), ustekinumab (Stelara ), adalimumab (Humira), and anakinra (Kineret).
In the 45 publications identified that reported the use of a biologic medication to treat erythrodermic or generalized pustular psoriasis, biologics were used in 91 cases of erythrodermic psoriasis – 23% of those had previously been treated with biologic therapy, whereas 14% had used multiple prior biologic therapies. Patients with erythrodermic psoriasis were an average of 37 years old and 28% were female.
Biologic therapy was used in 55 cases of generalized pustular psoriasis, 40% of which had used prior biologic therapy, and 17% of which used multiple prior biologic therapies. Patients with generalized pustular psoriasis were an average of 44 years old and 73% were female.
On average, patients in both groups failed at least two traditional systemic medications, including cyclosporine, methotrexate, or acitretin.
“Although the evidence is limited, biologic therapy appears to be effective in treating erythrodermic and generalized pustular psoriasis. In order to assess the comparative efficacy and safety of the biologic medications, larger controlled studies are needed,” the researchers concluded.
Larger controlled studies are needed to assess the comparative efficacy and safety of the biologic medications, they added.