Biologics may be a promising treatment for pediatric patients with generalized pustular psoriasis (GPP) who are not responding to traditional therapies, but clinical trials better establishing their safety and efficacy in this infrequently studied young patient group are needed, researchers at the University of Central Florida College of Medicine reported.
Their review study, titled “Biologics and Pediatric Generalized Pustular Psoriasis: An Emerging Therapeutic Trend,” was published in Cureus journal.
Psoriasis is a chronic autoimmune disease characterized by apparent abnormal skin patches. When the patches cover the entire body with pus-filled blisters instead of plaques, it leads to GPP, an extremely rare form of childhood psoriasis that affects 3 percent of patients.
From the therapeutic viewpoint, due of lack of randomized controlled trials in pediatric psoriasis patients, the management of GPP is often challenging and complex. Pediatric psoriasis is usually managed through topical treatments, as well as prevention of triggers.
In adults and young children, however, interest is growing in biologic agents, consisting of genetically engineered proteins issued from human genes designed to block components responsible for creating immune inflammation. This includes agents like etanercept, infliximab, and adalimumab. However, the efficacy and safety of these biologic agents in pediatric GPP are not fully clear.
Researchers compared the efficacy and safety of three available biologic agents, Enbrel (etanercept), Remicade (infliximab), and Humira (adalimumab), in the treatment of pediatric GPP. They conducted a review search of PubMed literature of all reported cases of primarily pustular psoriasis, and particularly GPP, and identified 12 studies that fit with their inclusion criteria. The analysis of these studies suggested that Enbrel ranks as a possible first-line biologic agent for pediatric psoriasis, including GPP, in terms of efficacy and safety, followed by Remicade and Humira.
“Overall, more reports on the effects and efficacy of biologic agents on pediatric psoriasis patients are slowly becoming available. If tolerated or indicated, pediatric GPP patients may begin therapy with one of the ‘traditional treatments’. However, if these are contraindicated, not successful, or undesired (i.e. etretinate in a reproductive-aged female), biologic agents, such as etanercept, infliximab, or adalimumab, may prove to be an effective alternative, as evidenced by the available literature, ” the authors concluded.
But, they added: “While these studies are informative, they do not insinuate that the demonstrated safety profiles and adverse outcomes findings translate directly to pediatric GPP patients. … The literature on biologics use in pediatric GPP is slowly growing, and additional testing is still required to determine efficacy in a larger population, proper dosing, and adverse effect profiles,” they added.