Spesolimab Treatment in GPP: Impact of IL-36RN Mutations and Concomitant Plaque Psoriasis

Wei Li,1– 3,* Jingyao Liang,2,* Yuwu Luo,2 Shuting Chen,2 Manqi Xia,2 Hui Ye,2 Bin Yang,1,3 Quan Luo2 1Department of Dermatology, First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China; 2Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, 510095, People’s Republic of China; 3Department of Dermatology, Dermatology Hospital of Southern Medical University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bin Yang, Email [email protected] Quan Luo, Email [email protected]: We present a case series involving five patients with generalized pustular psoriasis (GPP) who received a single intravenous dose of 900 mg spesolimab in our department from September 2023 to January 2024. Spesolimab was effective in three patients, regardless of their IL-36RN gene mutation status. Two patients with concomitant plaque psoriasis, despite initially poor responses to spesolimab, achieved resolution of pustules after switching their therapy to ixekizumab or secukinumab. This study highlights the potential of spesolimab in managing GPP, especially in genetically distinct groups, and emphasizes the importance of tailored therapeutic approaches. These findings suggest that spesolimab can effectively treat GPP, regardless of IL-36RN gene mutation status. However, its therapeutic efficacy may be suboptimal in patients with concomitant plaque psoriasis, indicating the need for further investigation to optimize treatment outcomes in this subgroup.Keywords: spesolimab, generalized pustular psoriasis, IL-36RN mutations