Bimekizumab effectively clears skin lesions in severe palmoplantar pustular psoriasis: JAMA

In the multicenter case series 21 patients with PPP or palmoplantar plaque psoriasis with pustules were treated with bimekizumab for at least three months. The study showed that 17 patients achieved complete clearance ((Investigator Global Assessment [IGA] score of 0) in 1 to 4 months, 3 patients had an IGA score of 1 implying almost clear and 1 had an IGA score of 2 (mild).

Two patients with SAPHO syndrome had completed clearance of skin lesions and improvement in joint pain.

Among the types of localized pustular psoriasis, PPP is defined as persistent (>3 months), primary, sterile, macroscopically visible pustules on palms or soles that can occur without or with psoriasis vulgaris according to a consensus statement by the ERASPEN Network. In some cases, PPP is associated with joint and bone inflammation in SAPHO syndrome. Additionally, palmoplantar plaque psoriasis with pustules is a localized plaque psoriasis with the co-occurrence of pustules.

Palmoplantar pustulosis and palmoplantar plaque psoriasis with pustules remain challenging to treat. Previous studies have indicated that an interleukin 17 or interleukin 36 loop acts synergistically to induce palmoplantar pustules in these diseases. Thierry Passeron and colleagues from France conducted a study to assess the effectiveness of bimekizumab in treating PPP and palmoplantar plaque psoriasis with pustules.

The case series included 21 adults (mean age, 46 years; 19 females) with PPP (n=11) or palmoplantar plaque psoriasis with pustules (n=10) treated at 1 of 7 tertiary dermatological centres in France from 2022 to 2023. The analyses included all patients treated with bimekizumab for at least 3 months.

The study's main outcome was the posttreatment IGA, which scored 0 (complete clearance), 1 (almost clear), 2 (mild), 3 (moderate), or 4 (severe). When relevant, the evolution of nail involvement and joint pain was reported. Potential adverse events and tolerance were noted.

Based on the study, the researchers reported the following findings:

• All of them, except 2 who received bimekizumab as first systemic therapy, had not responded to at least 1 systemic treatment (median, 3 treatments), and/or had adverse events leading to the discontinuation of the treatment.
• Complete clearance (IGA score, 0) was achieved by 17 patients in 1 to 4 months.
• Three patients achieved an IGA score of 1, and 1 achieved an IGA score of 2.
• Three patients with PPP also presented with acrodermatitis continua of Hallopeau. Nail involvement showed 50% to 70% improvement after 4 to 6 months of bimekizumab treatment for these three patients.
• Two patients had SAPHO syndrome; both had complete clearance of skin lesions associated with joint pain improvement.
• 19% of patients with candidiasis were successfully treated with oral antifungal agents.
• None of the patients had to stop bimekizumab treatment due to adverse events.

"The results suggest that bimekizumab could be an appealing approach for treating palmoplantar plaque psoriasis with pustules, PPP, and SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome," the researchers wrote.

"To confirm these encouraging initial results, a prospective placebo-controlled randomized clinical trial is warranted," they concluded.

Reference:

Passeron T, Perrot J, Jullien D, et al. Treatment of Severe Palmoplantar Pustular Psoriasis With Bimekizumab. JAMA Dermatol. Published online December 06, 2023. doi:10.1001/jamadermatol.2023.5051