Real-world clinical characteristics and treatment patterns of generalized pustular psoriasis flares

Abstract

Background

Clinical characteristics and treatment of generalized pustular psoriasis (GPP) flares are poorly understood.

Objective

To characterize patients by GPP flare status, quantify flare timing/frequency, and understand peri-flare treatment patterns.

Methods

This cohort study utilized electronic health records (2017-2023) from outpatient dermatology clinics in the OMNY Health real-world data platform. Patients were indexed at first GPP diagnosis code; encounter-level GPP flare status was established from previously developed algorithms. Annualized flare rate, time between flares, and peri-flare treatment patterns were described.

Results

Four hundred four of 638 patients (63%) experienced ≥1 flare episode. Patients who experienced a flare were more likely to be female, younger, nonwhite, Hispanic/Latino, have infectious/parasitic disease history, and more active GPP. Mean (median) annualized flare rate was 0.91 (0.51) flares/patient/year; mean (median) time between flares was 5.9 (3.8) months. Prescriptions increased from preflare period to flare episode, then decreased during the postflare period. Frequent treatment alterations of off-label biologics and nonsteroidal systemic agents were observed.

Limitations

Data were from US-based outpatient dermatology practices; documentation of GPP flares may not have been comprehensive or consistent in this setting.

Conclusion

GPP patients continue to experience frequent flares with traditional off-label therapies. Patients' course of treatment was altered frequently, suggesting an unmet need for effective long-term GPP therapies.