Real-world data on the clinical use of secukinumab in pediatric generalized pustular psoriasis: a 48-week retrospective study
Generalized pustular psoriasis (GPP) is a recurrent life-threatening disease and usually uncommon in children. Secukinumab, an interleukin (IL) -17 inhibitor, has been shown to be effective in the treatment of GPP in adult patients. However, there is currently a lack of evidence for its long-term efficacy and safety in the pediatric GPP population. This is a descriptive retrospective study that collected data from 18 pediatric patients with moderate to severe GPP treated with secukinumab in our department from July 2019 to August 2020, with 48 weeks of follow-up. Patient demographics and treatment characteristics were assessed. Response to secukinumab was evaluated by body temperature changes, laboratory examination assessments, Generalized Pustular Psoriasis Physician Global Assessment (GPPASI) scores, Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) scores, Children's Dermatology Life Quality Index (CDLQI) scores, and Pediatric Quality of Life Inventory (pedsQL) scores. Adverse events were also recorded. All patients achieved GPPASI 50 at week 2 and GPPASI 75 at week 4. From week 12 to week 48, most patients achieved GPPASI 100 and only five patients did not reach GPPASI 100 due to minimal relapse. At week 2, the mean absolute GPPASI had a sharply decrease from 31.7 to 5.1 and improved further to 1.3 in week 4. Patients’ body temperature returned to normal at day 3. Pustules subsided within 3 days, erythema and scales decreased rapidly in the second week. The average CDLQI score decreased rapidly from 13.6 to 1.8 at week 4 and to 0 at week 48. For pedsQL scores, Physical Health Summary Score and Psychosocial Health Summary Score (mean change from baseline) improved gradually over time. All patients were followed for 48 weeks, and no serious adverse events were observed. Side effects that occurred in nine patients were mild and manageable. In conclusion, GPP systemic inflammation and skin symptoms did rapidly improve with the treatment of secukinumab, and this curative effect was maintained for 48 weeks without any unexpected safety signal. Our study shows that secukinumab could be an effective treatment option for pediatric patients with GPP.