Treatments and outcomes of generalized pustular psoriasis: A cohort of 1516 patients in a nationwide inpatient database in Japan - 27/06/21

Doi : 10.1016/j.jaad.2021.06.008

Hideaki Miyachi, MD, PhD ^a,^⁎ , Takaaki Konishi, MD ^b, Ryosuke Kumazawa, MPharm ^b, Hiroki Matsui, MPH ^b, Sayuri Shimizu, PhD ^c, Kiyohide Fushimi, MD, PhD ^d, Hiroyuki Matsue, MD, PhD ^a, Hideo Yasunaga, MD, PhD ^b
^a Department of Dermatology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
^b Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
^c Departmant of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
^d Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan

^∗Correspondence to: Hideaki Miyachi, MD, PhD, Department of Dermatology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.Department of DermatologyGraduate School of MedicineChiba University1-8-1 InohanaChuo-kuChiba260-8670Japan

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Abstract

Background

Because generalized pustular psoriasis (GPP) is rare, there are few studies reporting treatments and outcomes for large numbers of patients.

Objective

To report treatments and outcomes in a large cohort of patients hospitalized with GPP.

Methods

Using a Japanese national inpatient database, we identified 1516 patients with GPP who required hospitalization between July 2010 and March 2019. We categorized patients into 3 medication groups: biologics (294 patients), oral agents without biologics (948 patients), and systemic corticosteroids only (274 patients). We investigated their characteristics, treatments, and outcomes.

Results

Mean age was 66 years (interquartile range: 52-77 years). Fifty patients (3.3%) were admitted to the intensive care unit, 125 (8.2%) required blood pressure support, and 63 (4.2%) died. Patients who received biologics were younger and had fewer comorbidities. In-hospital mortality was lower in the biologics group (1.0% [biologics group] vs 3.7% [oral-agents group] vs 9.1% [corticosteroids-only group]; P < .001) as was morbidity (5.4% vs 8.2% vs 12%, respectively; P = .02). Among those who received biologics, IL-17 inhibitor use increased over time, with in-hospital mortality and morbidity comparable to those of tumor necrosis factor inhibitors.

Limitations

Retrospective study design. Some patients received multiple medications.

Conclusion

Biologic treatments showed favorable outcomes compared with other treatments.

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Key words : adalimumab, brodalumab, generalized pustular psoriasis, GPP, infliximab, interleukin-17, interleukin-23, ixekizumab, psoriasis, secukinumab, tumor necrosis factor inhibitor, ustekinumab

Abbreviations used : BMI, GPP, ICD-10, ICU, IL, TNF

Plan

	Funding sources: This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and 20AA2005) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907 and 21K08294).
	IRB approval status: The Institutional Review Board at The University of Tokyo approved this study (approval number: 3501; October 20, 2011).
	Reprints not available from the authors.