Pyoderma Gangrenosum and Interleukin Inhibitors: A Semi-Systematic Review

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Pyoderma gangrenosum (PG) is a rare, severe ulcerative skin disease with significant comorbidities and mortality.
• Current treatment options for PG are limited, with a growing interest in biologics like interleukin inhibitors.
• Existing literature on interleukin inhibitors for PG is sparse, primarily consisting of case reports and series.

Purpose of the Study:

• To systematically review and evaluate the efficacy and safety of interleukin inhibitors in treating adult patients with pyoderma gangrenosum.
• To synthesize available evidence on response rates and adverse events associated with interleukin inhibitor therapy for PG.

Main Methods:

• A comprehensive literature search was performed across major databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library).
• Inclusion criteria focused on adult patients diagnosed with PG and treated with any interleukin inhibitor.
• Data from 60 papers involving 81 patients were analyzed.

Main Results:

• Interleukin inhibitor treatment demonstrated a 70% overall response rate and a 57% complete response rate in adult PG patients.
• Adverse events were infrequent (4%) and generally mild.
• Specific response rates varied: anakinra (59% response, 38% complete), canakinumab (64% response, 55% complete), and ustekinumab (79% response, 71% complete).

Conclusions:

• Off-label use of interleukin inhibitors is supported for managing recalcitrant pyoderma gangrenosum in adults due to observed efficacy and favorable safety profile.
• Publication bias may overestimate efficacy; further studies are required to compare different interleukin inhibitors and understand treatment response in relation to underlying conditions.