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RECOGNISING GPP FLARES

IDENTIFY THE CHARACTERISTICS OF GPP FLARES

Generalized Pustular Psoriasis (GPP) flares are characterised by eruptions of neutrophilic pustules and worsening lesions.1,2 These symptoms can occur with or without systemic inflammation and with or without Plaque Psoriasis.3,4

HOW GPP FLARES CAN MANIFEST ON PATIENTS' SKIN

The most-cited GPP symptoms include pustules and worsening lesions.1

Image of skin with pustules

Image used with permission from Dr Siew Eng Choon.

Image of skin with pustules

IMAGE USED WITH PERMISSION FROM DR MAHIRA
HAMDY EL SAYED.

OTHER SYMPTOMS MAY INCLUDE1,5-8:

itching

ITCHING

scaling

SCALING

dryness

DRYNESS

erythema

ERYTHEMA

Pain

PAIN

swelling

SWELLING

Burning sensation

BURNING SENSATION

discomfort

DISCOMFORT

fever

FEVER

leukocytosis

LEUKOCYTOSIS

joint_pain

JOINT PAIN

fatigue

FATIGUE

Headache

HEADACHE

WATCH THE VIDEO FOR MORE ABOUT GPP FLARES AND THEIR EXCUTANEOUS MANIFESTATIONS1

GPP FLARES MAY REQUIRE SAME-DAY MEDICAL ASSESSMENT9

There are serious complications associated with GPP to consider. These include acute respiratory distress syndrome (ARDS), sepsis, cardiovascular aseptic shock, high-output cardiac failure, renal failure, neutrophilic cholangitis, metabolic abnormalities, osteoarthritis, and uveitis. The most common causes of death associated with GPP are sepsis, ARDS, and cardiac failure.3,6,7,10-12

THE UNPREDICTABLE NATURE OF FLARES MAKES GPP CHALLENGING TO CONTROL10

GPP flares can vary among patients and present differently within the same patient.10 Because of this, previous flare episodes do not indicate the severity or duration of the next flare.10 Due to the significant burden of disease, it is important to stabilise patients to prevent escalation.3,7,10

GPP HAS A SIGNIFICANT CLINICAL BURDEN1,3,12

If left untreated, GPP symptoms can escalate, may result in hospitalisation, and may become life-threatening.1,3,12

Patients diagnosed with GPP experience at least 1 flare resulting in hospitalisation every 1 to 5 years due to GPP and associated comorbidities.3,7,10-12

These flares can last from weeks to months, and may adversely affect every aspect of a patient's life.1,3,11 The duration of GPP flares and their time to resolution may vary.1,6

Surveyed dermatologists have reported that the duration of GPP flares and time to resolution may vary1

Chart flares

 

CONSIDER HOW GPP CAN AFFECT PATIENTS3,11

Severe GPP symptoms can make it difficult for patients to complete daily activities.11 A recent study using the Corrona Psoriasis Registry showed that median patient-reported pain, itching, and fatigue was higher with GPP than with Plaque Psoriasis.13

GPP_Medscape_Email_GPPvsPlaquePso_Chart

GPP symptoms can also have a substantial impact on patients' social relationships and mental health.14 For example, GPP is associated with higher rates of anxiety and depression disorders.15

UNDERSTAND MORE ABOUT GPP FLARES AND THE NEED FOR EFFECTIVE TREATMENTS1,11

THERE IS A HIGH UNMET NEED IN GPP1,11

Effective, fast-acting, GPP-specific therapies are needed to control GPP flares.1,11 Currently, no approved GPP-specific therapies supported by randomised clinical trials exist.1

Due to limited data, current therapies used to treat GPP lack established efficacy and safety profiles.16,17 Also, few guidelines for the specific treatment of GPP exist.1,18

TARGETED THERAPIES ARE NEEDED TO:

  • Rapidly and effectively resolve GPP flares1,11
  • Have an acceptable safety profile1,11,19
  • Replace current treatment options that have limited efficacy1,11,19
  • Provide sustained disease control1

targeted therapies are needed to
References
  • 1.
    Strober B, Kotowsky N, Medeiros R, et al. Unmet medical needs in the treatment and management of generalized pustular psoriasis flares: evidence from a survey of Corrona registry dermatologists. Dermatol Ther (Heidelb). 2021;11(2):529-541. doi:10.1007/s13555-021-00493-0
  • 2.
    Choon SE, Lebwohl MG, Marrakchi S, et al. Study protocol of the global Effisayil 1 phase II, multicentre, randomised, double-blind, placebo-controlled trial of spesolimab in patients with generalized pustular psoriasis presenting with an acute flare. BMJ Open. 2021;11(3):e043666. doi:10.1136/bmjopen-2020-043666
  • 3.
    Gooderham MJ, Van Voorhees AS, Lebwohl MG. An update on generalized pustular psoriasis. Expert Rev Clin Immunol. 2019;15(9):907-919. doi:10.1080/1744666X.2019.1648209
  • 4.
    Navarini AA, Burden AD, Capon F, et al; for the ERASPEN Network. European consensus statement on phenotypes of pustular psoriasis. J Eur Acad Dermatol Venereol. 2017;31(11):1792-1799. doi:10.1111/jdv.14386
  • 5.
    Skalicky A, Rentz A, Esser D, Thoma C, Gloede T. Symptom experience of patients with generalized pustular psoriasis (GPP). Value in Health. 2020;23(suppl 1):S345. Abstract: PRO89. doi:10.1016/j.jval.2020.04.1310
  • 6.
    Bachelez H. Pustular psoriasis: the dawn of a new era. Acta Derm Venereol. 2020;100(3):adv00034. doi:10.2340/00015555-3388
  • 7.
    Choon SE, Lai NM, Mohammad NA, Nanu NM, Tey KE, Chew SF. Clinical profile, morbidity, and outcome of adult-onset generalized pustular psoriasis: analysis of 102 cases seen in a tertiary hospital in Johor, Malaysia. Int J Dermatol. 2014;53(6):676-684. doi:10.1111/ijd.12070
  • 8.
    Shah M, Al Aboud DM, Crane JS, Kumar S. Pustular psoriasis. StatPearls. Updated August 10, 2020. Accessed June 2, 2021. https://www.ncbi.nlm.nih.gov/books/NBK537002/
  • 9.
    Psoriasis: assessment and management. NICE Clinical Guideline [CG153]. National Institute for Health and Care Excellence. Published October 24, 2012. Updated September 2017. Accessed June 2, 2021. www.nice.org.uk/guidance/cg153
  • 10.
    Bachelez H. Pustular psoriasis and related pustular skin diseases. Br J Dermatol. 2018;178(3):614-618. doi:10.1111/bjd.16232
  • 11.
    Kharawala S, Golembesky AK, Bohn RL, Esser D. The clinical, humanistic, and economic burden of generalized pustular psoriasis: a structured review. Expert Rev Clin Immunol. 2020;16(3):239-252. doi:10.1080/1744666X.2019.1708193
  • 12.
    Ly K, Beck KM, Smith MP, Thibodeaux Q, Bhutani T. Diagnosis and screening of patients with generalized pustular psoriasis. Psoriasis (Auckl). 2019;9:37-42. doi:10.2147/PTT.S181808
  • 13.
    Strober B, Kotowsky N, Medeiros RA, et al. Patient-reported outcomes from a large, North American-based cohort highlight a greater disease burden for generalized pustular psoriasis versus plaque psoriasis: real-world evidence from the Corrona Psoriasis Registry. Poster presented at: American Academy of Dermatology Virtual Meeting Experience; April 23-25, 2021.
  • 14.
    Sampogna F, Tabolli S, Söderfeldt B, Axtelius B, Aparo U, Abeni D; for the IMPROVE Investigators. Measuring quality of life of patients with different clinical types of psoriasis using the SF-36. Br J Dermatol. 2006;154(5):844-849. doi:10.1111/j.1365-2133.2005.07071.x
  • 15.
    Kotowsky N, Gao R, Singer D, Garry E, Golembesky AK. Healthcare resource utilization (HCRU) in patients with generalized pustular psoriasis (GPP): a claims database study. Value in Health. 2020;23(suppl 1):S333-S334. Abstract: PRO29. doi:10.1016/j.jval.2020.04.1257
  • 16.
    Fujita H, Terui T, Hayama K, et al. Japanese guidelines for the management and treatment of generalized pustular psoriasis: the new pathogenesis and treatment of GPP. J Dermatol. 2018;45(11):1235-1270. doi:10.1111/1346-8138.14523
  • 17.
    Robinson A, Van Voorhees AS, Hsu S, et al. Treatment of pustular psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012;67(2):279-288. doi:10.1016/j.jaad.2011.01.032
  • 18.
    Benjegerdes KE, Hyde K, Kivelevitch D, Mansouri B. Pustular psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl). 2016;6:131-144. doi:10.2147/PTT.S98954
  • 19.
    Imafuku S, Honma M, Okubo Y, et al. Efficacy and safety of secukinumab in patients with generalized pustular psoriasis: a 52-week analysis from phase III open-label multicenter Japanese study. J Dermatol. 2016;43(9):1011-1017. doi:10.1111/1346-8138.13306