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Updated: May 12, 2026

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Treating Generalized Pustular Psoriasis (GPP): Timing and Rationale for Biologic Treatment Switching-A Japanese

Yayoi Tada1, Shinichi Imafuku2, Kazumitsu Sugiura3

  • 1Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, Japan. ytada-tky@umin.ac.jp.

Dermatology and Therapy
|March 23, 2025
PubMed
Summary

Expert consensus indicates that switching biologic treatments for generalized pustular psoriasis (GPP) is infrequent, with decisions driven by lack of efficacy, side effects, and new treatment options. Further evidence is needed for optimal GPP management.

Keywords:
Biologic drugDelphiDriversGeneralized pustular psoriasisReasonsSwitching

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Area of Science:

  • Dermatology
  • Immunology
  • Pharmacology

Background:

  • Generalized pustular psoriasis (GPP) is a chronic inflammatory skin disease requiring effective treatment.
  • Biologic therapies are increasingly used for GPP in Japan, with a notable heterogeneity in real-world treatment patterns.
  • Understanding expert consensus on switching biologic treatments is crucial for optimizing GPP management.

Purpose of the Study:

  • To evaluate expert consensus among Japanese dermatologists regarding switching biologic treatments for generalized pustular psoriasis (GPP).
  • To identify key criteria influencing decisions to switch biologic therapies in GPP patients.

Main Methods:

  • A three-round Delphi exercise involving ten Japanese dermatologists.
  • Surveys assessed expert experience with biologics, switching patterns, timing, and decision-making criteria.
  • Consensus was defined as agreement among at least 70% of participants.

Main Results:

  • Most experts rarely or never switch biologics during acute GPP flares, with only 20% switching frequently.
  • Key factors influencing switching decisions include lack of efficacy, loss of efficacy, side effects, contraindications, and new therapeutic options.
  • Safety, infection risk, and adherence also play significant roles in treatment modification.

Conclusions:

  • Biologic treatment switches in GPP are primarily driven by loss of effectiveness during flares or insufficient initial response.
  • Decisions to switch are influenced by a combination of efficacy, safety, and the availability of superior alternatives.
  • There is an ongoing need for robust evidence to guide biologic treatment choices in GPP.