Real-world treatment patterns in patients with generalized pustular psoriasis: A US-based claims study

Generalized pustular psoriasis (GPP) is a chronic and life-threatening inflammatory skin disease, distinct from psoriasis (PsO). There is a lack of GPP treatment guidelines.

To characterize treatment patterns among patients with GPP in the US during two 365-day periods (postdiagnosis and prediagnosis) between 2015 and 2020.

Using a claims database, 3 cohorts were identified (All-GPP, GPP + PsO, GPP-only) from International Classification of Diseases, 10th revision codes.

The study comprised of 2630 patients in the All-GPP cohort (n = 1246 GPP-only, n = 1384 GPP + PsO). Topical corticosteroids were the most frequently prescribed treatment postdiagnosis, followed by systemic corticosteroids: GPP + PsO (55.7% and 40.4%, respectively), GPP-only (51.5% and 42.0%). In the GPP + PsO vs GPP-only cohort, systemic biologics (39.6% vs 21.5%) and nonbiologics (36.9% vs 29.1%) were prescribed more frequently postdiagnosis. In each cohort, use of systemic and topical corticosteroids was lower postdiagnosis vs prediagnosis, whereas use of other therapeutics (topical vitamin D derivates, retinoids, systemic biologics, systemic nonbiologics, phototherapy) was higher.

Data collected before US Food and Drug Administration approval of the first biologic for GPP (spesolimab).

Corticosteroids were frequently prescribed, despite published reports of GPP flare following withdrawal, and fewer GPP-only than GPP + PsO patients received biologics, consistent with the lack of US Food and Drug Administration-approved targeted therapies for GPP during the study.