These articles have been accepted for publication in the British Journal of Dermatology and are currently being edited and typeset. Readers should note that articles published below have been fully refereed, but have not been through the copy-editing and proof correction process. WileyBlackwell and the British Association of Dermatologists cannot be held responsible for errors or consequences arising from the use of information contained in these articles; nor do the views and opinions expressed necessarily reflect those of Wiley-Blackwell or the British Association of Dermatologists This article is protected by copyright. All rights reserved. Received Date : 21-Oct-2014 Revised Date : 26-Nov-2014 Accepted Date : 02-Dec-2014 Article type
: Case Report
Title: Treatment of two patients with generalised pustular psoriasis with the interleukin-1β inhibitor gevokizumab
Authors: B. Mansouri1, L. Richards2, A. Menter3 1
Clinical Research Fellow
Division of Dermatology, Baylor University Medical Center 3900 Junius Street, Suite 125, Dallas, Texas 75204 2
Medical Student
Texas A&M Health Science Center College of Medicine 3
Clinical Professor of Dermatology
Chief, Division of Dermatology, and Director, Dermatology Residency Program Division of Dermatology, Baylor University Medical Center
This article is protected by copyright. All rights reserved. 3900 Junius Street, Suite 125, Dallas, Texas 75204
Corresponding author: Alan Menter, MD Director, Baylor University Medical Center Psoriasis Research Chief, Division of Dermatology 3900 Junius Street, Suite 125 Dallas, TX 75246 Email: [email protected] Phone: 972-354-7988, Fax: 972-715-1460
Funding source: XOMA (US) LLC provided gevokizumab at no cost to the patients. The sponsor was involved in the design of the study, the review and approval of the manuscript, and the decision to submit the manuscript for publication.
Conflicts of Interest: Dr. Menter has sat on the advisory boards of AbbVie, Allergan, Amgen, Boehringer Ingelheim, Genentech, Janssen Biotech, Inc., LEO Pharma, and Pfizer, has been a consultant for AbbVie, Allergan, Amgen, Convoy Therapeutics, Inc., Ely Lilly, Janssen Biotech, Inc., LEO Pharma, Novartis, Pfizer, Syntrix, Wyeth, XenoPort, and XOMA (US) LLC, has been an investigator for AbbVie, Allergan, Amgen, ApoPharma, Boehringer Ingelheim, Celgene, Convoy Therapeutics, Inc., Ely Lilly, Genentech, Janssen Biotech, Inc., LEO Pharma, Merck, Novartis, Pfizer, Symbio/Maruho, Syntrix, Wyeth, and XOMA (US) LLC, has been a speaker for AbbVie, Amgen, Janssen Biotech, Inc., LEO Pharma, and Wyeth, and received grants and/or
This article is protected by copyright. All rights reserved. home that led to the formation of a small hematoma on his flank, which became a nidus for infection given the status of his skin’s barrier function. The patient is currently well controlled with occasional flares on a combination of adalimumab and acitretin. Patient 2 was a 59 year-old white female with a 6-month history of severe recalcitrant GPP, which had evolved from a prior diagnosis of localized palmoplantar pustulosis and who had no evidence of plaque psoriasis. She had previously failed etanercept, adalimumab, adalimumab with methotrexate, and cyclosporine. At study day zero, the BSA was 36% and the GPPASI score was 14.4 (Table 1). At week 12, a 65% reduction in GPPASI was achieved. Dermatology life quality index (DLQI) values indicated that her skin disease continued to have a large effect on her quality of life, as is commonly seen in patients with palmoplantar disease. In addition, our previously published palmoplantar life quality instrument6 indicated a total lack of ability to use her hands and feet. Given the continued impact of the disease on her quality of life, the patient elected to discontinue from the study and is currently moderately controlled on infliximab and methotrexate.
Discussion There is a considerable potential for the use of IL-1β inhibitors for treating conditions of widespread pustulosis followed the discovery of the deficiency in the IL-1 receptor antagonist (DIRA)7 and the subsequent analogous deficiency in the IL-36 receptor antagonist (DITRA) in familial GPP1. IL-1β inhibitors have shown efficacy in GPP and other pustular conditions, including cases of DIRA, DITRA, and palmoplantar pustulosis5, 7-10. Both our patients showed substantial initial clinical response to gevokizumab with no significant laboratory abnormalities
This article is protected by copyright. All rights reserved. 5. Viguier M, Guigue P, Pages C, Smahi A , Bachelez H. Successful treatment of generalized pustular psoriasis with the interleukin-1-receptor antagonist Anakinra: lack of correlation with IL1RN mutations. Annals of internal medicine 2010;153:66-7. 6. Farley E, Masrour S, McKey J , Menter A. Palmoplantar psoriasis: a phenotypical and clinical review with introduction of a new quality-of-life assessment tool. Journal of the American Academy of Dermatology 2009;60:1024-31. 7. Aksentijevich I, Masters SL, Ferguson PJ, Dancey P, Frenkel J, van Royen-Kerkhoff A et al. An autoinflammatory disease with deficiency of the interleukin-1-receptor antagonist. The New England journal of medicine 2009;360:2426-37. 8. Tauber M, Viguier M, Alimova E, Petit A, Liote F, Smahi A et al. Partial clinical response to anakinra in severe palmoplantar pustular psoriasis. The British journal of dermatology 2014. 9. Rossi-Semerano L, Piram M, Chiaverini C, De Ricaud D, Smahi A , Kone-Paut I. First clinical description of an infant with interleukin-36-receptor antagonist deficiency successfully treated with anakinra. Pediatrics 2013;132:e1043-7. 10. Minkis K, Aksentijevich I, Goldbach-Mansky R, Magro C, Scott R, Davis JG et al. Interleukin 1 receptor antagonist deficiency presenting as infantile pustulosis mimicking infantile pustular psoriasis. Archives of dermatology 2012;148:747-52.
FIGURE 1 Legend: Clinical photographs of patient 1 with generalised pustular psoriasis at (a) week 0, (b) week 2, and (c) week 4 following one dose of gevokizumab.
This article is protected by copyright. All rights reserved. We conducted an open-label, expanded access study at our specialty clinic of gevokizumab (XOMA (US) LLC, Berkeley, CA, USA), a monoclonal antibody against IL-1β, in two patients with severe, recalcitrant GPP. The expanded access to this medication was approved by the United States Food and Drug Administration. Studying this medication was approved in both patients by a central institutional review board. After signing written informed consent, both patients were washed out of prior biological therapies for 12 weeks and oral therapies for 4 weeks. Patients were scheduled to receive gevokizumab 60 mg subcutaneously every 4 weeks for a total of 3 injections (12 weeks) with 4 weeks of follow up.
Case Reports Patient 1 was a 35 year-old white male with a 6-month history of acute onset GPP without prior evidence of plaque psoriasis. His disease was recalcitrant to the combination of infliximab up to a dosage of 10 mg/kg every 4 weeks plus cyclosporine up to 5 mg/kg daily. At study day zero, the patient was non-ambulatory due to his severe, debilitating cutaneous disease. Body surface area (BSA) involvement was 97%, with generalized psoriasis area and severity index (GPPASI) score being 69.6 (Table 1). GPPASI is calculated using the exact methodology as the psoriasis area and severity index (PASI) score, except the scale score is substituted with a score for pustules. By week four, the patient was ambulatory with an assistive device with a 79% improvement in the GPPASI score (Fig. 1). At week five, one week following his second gevokizumab injection, the study was discontinued due to a flank abscess, which required incision and drainage and systemic antibiotics. It was unlikely that the gevokizumab was directly related to the patient’s abscess formation, as the medication had significantly decreased the patient’s overall pustulosis. The most likely cause was a recent fall the patient had sustained at
This article is protected by copyright. All rights reserved. home that led to the formation of a small hematoma on his flank, which became a nidus for infection given the status of his skin’s barrier function. The patient is currently well controlled with occasional flares on a combination of adalimumab and acitretin. Patient 2 was a 59 year-old white female with a 6-month history of severe recalcitrant GPP, which had evolved from a prior diagnosis of localized palmoplantar pustulosis and who had no evidence of plaque psoriasis. She had previously failed etanercept, adalimumab, adalimumab with methotrexate, and cyclosporine. At study day zero, the BSA was 36% and the GPPASI score was 14.4 (Table 1). At week 12, a 65% reduction in GPPASI was achieved. Dermatology life quality index (DLQI) values indicated that her skin disease continued to have a large effect on her quality of life, as is commonly seen in patients with palmoplantar disease. In addition, our previously published palmoplantar life quality instrument6 indicated a total lack of ability to use her hands and feet. Given the continued impact of the disease on her quality of life, the patient elected to discontinue from the study and is currently moderately controlled on infliximab and methotrexate.
Discussion There is a considerable potential for the use of IL-1β inhibitors for treating conditions of widespread pustulosis followed the discovery of the deficiency in the IL-1 receptor antagonist (DIRA)7 and the subsequent analogous deficiency in the IL-36 receptor antagonist (DITRA) in familial GPP1. IL-1β inhibitors have shown efficacy in GPP and other pustular conditions, including cases of DIRA, DITRA, and palmoplantar pustulosis5, 7-10. Both our patients showed substantial initial clinical response to gevokizumab with no significant laboratory abnormalities
This article is protected by copyright. All rights reserved. noted. These two cases illustrate the growing need for targeted, safe, and efficacious therapies for this severe, debilitating disease. Prospective randomized control trials are required to assess the safety and efficacy of IL-1β inhibitors for the treatment of GPP.
Acknowledgements: We are indebted to Jennifer Whitmore, Rajneesh Nath, and Peter Foote of XOMA (US) LLC for their collaboration in this study. XOMA (US) LLC provided gevokizumab at no cost to the patients. The sponsor was involved in the design of the study, the review and approval of the manuscript, and the decision to submit the manuscript for publication.
References: 1. Marrakchi S, Guigue P, Renshaw BR, Puel A, Pei XY, Fraitag S et al. Interleukin-36-receptor antagonist deficiency and generalized pustular psoriasis. The New England journal of medicine 2011;365:620-8. 2. Sugiura K, Takemoto A, Yamaguchi M, Takahashi H, Shoda Y, Mitsuma T et al. The majority of generalized pustular psoriasis without psoriasis vulgaris is caused by deficiency of interleukin36 receptor antagonist. The Journal of investigative dermatology 2013;133:2514-21. 3. Robinson A, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Bebo BF, Jr. et al. Treatment of pustular psoriasis: from the Medical Board of the National Psoriasis Foundation. Journal of the American Academy of Dermatology 2012;67:279-88. 4. Viguier M, Aubin F, Delaporte E, Pages C, Paul C, Beylot-Barry M et al. Efficacy and safety of tumor necrosis factor inhibitors in acute generalized pustular psoriasis. Archives of dermatology 2012;148:1423-5.
This article is protected by copyright. All rights reserved. 5. Viguier M, Guigue P, Pages C, Smahi A , Bachelez H. Successful treatment of generalized pustular psoriasis with the interleukin-1-receptor antagonist Anakinra: lack of correlation with IL1RN mutations. Annals of internal medicine 2010;153:66-7. 6. Farley E, Masrour S, McKey J , Menter A. Palmoplantar psoriasis: a phenotypical and clinical review with introduction of a new quality-of-life assessment tool. Journal of the American Academy of Dermatology 2009;60:1024-31. 7. Aksentijevich I, Masters SL, Ferguson PJ, Dancey P, Frenkel J, van Royen-Kerkhoff A et al. An autoinflammatory disease with deficiency of the interleukin-1-receptor antagonist. The New England journal of medicine 2009;360:2426-37. 8. Tauber M, Viguier M, Alimova E, Petit A, Liote F, Smahi A et al. Partial clinical response to anakinra in severe palmoplantar pustular psoriasis. The British journal of dermatology 2014. 9. Rossi-Semerano L, Piram M, Chiaverini C, De Ricaud D, Smahi A , Kone-Paut I. First clinical description of an infant with interleukin-36-receptor antagonist deficiency successfully treated with anakinra. Pediatrics 2013;132:e1043-7. 10. Minkis K, Aksentijevich I, Goldbach-Mansky R, Magro C, Scott R, Davis JG et al. Interleukin 1 receptor antagonist deficiency presenting as infantile pustulosis mimicking infantile pustular psoriasis. Archives of dermatology 2012;148:747-52.
FIGURE 1 Legend: Clinical photographs of patient 1 with generalised pustular psoriasis at (a) week 0, (b) week 2, and (c) week 4 following one dose of gevokizumab.
This article is protected by copyright. All rights reserved. TABLE 1 Week BSA (%) GPPASI PGA DLQI
0 97 69.6 5 30
Patient 1 2 77 35.8 5 30
4 62 22.1 3 26
0 36 14.4 4 30
2 32 14.7 4 30
Patient 2 4 33 11.3 4 23
8 23.5 7.7 3 17
12 5.7 5.0 2 17
Abbreviations: PASI = psoriasis area and severity index, BSA = body surface area, GPPASI = generalized pustular psoriasis area and severity index, PGA = physician’s global assessment, DLQI = dermatology life quality index Legend: Quantitative clinical parameters for both patients over their respective courses of therapy.
: Case Report
Title: Treatment of two patients with generalised pustular psoriasis with the interleukin-1β inhibitor gevokizumab
Authors: B. Mansouri1, L. Richards2, A. Menter3 1
Clinical Research Fellow
Division of Dermatology, Baylor University Medical Center 3900 Junius Street, Suite 125, Dallas, Texas 75204 2
Medical Student
Texas A&M Health Science Center College of Medicine 3
Clinical Professor of Dermatology
Chief, Division of Dermatology, and Director, Dermatology Residency Program Division of Dermatology, Baylor University Medical Center
This article is protected by copyright. All rights reserved. 3900 Junius Street, Suite 125, Dallas, Texas 75204
Corresponding author: Alan Menter, MD Director, Baylor University Medical Center Psoriasis Research Chief, Division of Dermatology 3900 Junius Street, Suite 125 Dallas, TX 75246 Email: [email protected] Phone: 972-354-7988, Fax: 972-715-1460
Funding source: XOMA (US) LLC provided gevokizumab at no cost to the patients. The sponsor was involved in the design of the study, the review and approval of the manuscript, and the decision to submit the manuscript for publication.
Conflicts of Interest: Dr. Menter has sat on the advisory boards of AbbVie, Allergan, Amgen, Boehringer Ingelheim, Genentech, Janssen Biotech, Inc., LEO Pharma, and Pfizer, has been a consultant for AbbVie, Allergan, Amgen, Convoy Therapeutics, Inc., Ely Lilly, Janssen Biotech, Inc., LEO Pharma, Novartis, Pfizer, Syntrix, Wyeth, XenoPort, and XOMA (US) LLC, has been an investigator for AbbVie, Allergan, Amgen, ApoPharma, Boehringer Ingelheim, Celgene, Convoy Therapeutics, Inc., Ely Lilly, Genentech, Janssen Biotech, Inc., LEO Pharma, Merck, Novartis, Pfizer, Symbio/Maruho, Syntrix, Wyeth, and XOMA (US) LLC, has been a speaker for AbbVie, Amgen, Janssen Biotech, Inc., LEO Pharma, and Wyeth, and received grants and/or
This article is protected by copyright. All rights reserved. home that led to the formation of a small hematoma on his flank, which became a nidus for infection given the status of his skin’s barrier function. The patient is currently well controlled with occasional flares on a combination of adalimumab and acitretin. Patient 2 was a 59 year-old white female with a 6-month history of severe recalcitrant GPP, which had evolved from a prior diagnosis of localized palmoplantar pustulosis and who had no evidence of plaque psoriasis. She had previously failed etanercept, adalimumab, adalimumab with methotrexate, and cyclosporine. At study day zero, the BSA was 36% and the GPPASI score was 14.4 (Table 1). At week 12, a 65% reduction in GPPASI was achieved. Dermatology life quality index (DLQI) values indicated that her skin disease continued to have a large effect on her quality of life, as is commonly seen in patients with palmoplantar disease. In addition, our previously published palmoplantar life quality instrument6 indicated a total lack of ability to use her hands and feet. Given the continued impact of the disease on her quality of life, the patient elected to discontinue from the study and is currently moderately controlled on infliximab and methotrexate.
Discussion There is a considerable potential for the use of IL-1β inhibitors for treating conditions of widespread pustulosis followed the discovery of the deficiency in the IL-1 receptor antagonist (DIRA)7 and the subsequent analogous deficiency in the IL-36 receptor antagonist (DITRA) in familial GPP1. IL-1β inhibitors have shown efficacy in GPP and other pustular conditions, including cases of DIRA, DITRA, and palmoplantar pustulosis5, 7-10. Both our patients showed substantial initial clinical response to gevokizumab with no significant laboratory abnormalities
This article is protected by copyright. All rights reserved. 5. Viguier M, Guigue P, Pages C, Smahi A , Bachelez H. Successful treatment of generalized pustular psoriasis with the interleukin-1-receptor antagonist Anakinra: lack of correlation with IL1RN mutations. Annals of internal medicine 2010;153:66-7. 6. Farley E, Masrour S, McKey J , Menter A. Palmoplantar psoriasis: a phenotypical and clinical review with introduction of a new quality-of-life assessment tool. Journal of the American Academy of Dermatology 2009;60:1024-31. 7. Aksentijevich I, Masters SL, Ferguson PJ, Dancey P, Frenkel J, van Royen-Kerkhoff A et al. An autoinflammatory disease with deficiency of the interleukin-1-receptor antagonist. The New England journal of medicine 2009;360:2426-37. 8. Tauber M, Viguier M, Alimova E, Petit A, Liote F, Smahi A et al. Partial clinical response to anakinra in severe palmoplantar pustular psoriasis. The British journal of dermatology 2014. 9. Rossi-Semerano L, Piram M, Chiaverini C, De Ricaud D, Smahi A , Kone-Paut I. First clinical description of an infant with interleukin-36-receptor antagonist deficiency successfully treated with anakinra. Pediatrics 2013;132:e1043-7. 10. Minkis K, Aksentijevich I, Goldbach-Mansky R, Magro C, Scott R, Davis JG et al. Interleukin 1 receptor antagonist deficiency presenting as infantile pustulosis mimicking infantile pustular psoriasis. Archives of dermatology 2012;148:747-52.
FIGURE 1 Legend: Clinical photographs of patient 1 with generalised pustular psoriasis at (a) week 0, (b) week 2, and (c) week 4 following one dose of gevokizumab.
This article is protected by copyright. All rights reserved. We conducted an open-label, expanded access study at our specialty clinic of gevokizumab (XOMA (US) LLC, Berkeley, CA, USA), a monoclonal antibody against IL-1β, in two patients with severe, recalcitrant GPP. The expanded access to this medication was approved by the United States Food and Drug Administration. Studying this medication was approved in both patients by a central institutional review board. After signing written informed consent, both patients were washed out of prior biological therapies for 12 weeks and oral therapies for 4 weeks. Patients were scheduled to receive gevokizumab 60 mg subcutaneously every 4 weeks for a total of 3 injections (12 weeks) with 4 weeks of follow up.
Case Reports Patient 1 was a 35 year-old white male with a 6-month history of acute onset GPP without prior evidence of plaque psoriasis. His disease was recalcitrant to the combination of infliximab up to a dosage of 10 mg/kg every 4 weeks plus cyclosporine up to 5 mg/kg daily. At study day zero, the patient was non-ambulatory due to his severe, debilitating cutaneous disease. Body surface area (BSA) involvement was 97%, with generalized psoriasis area and severity index (GPPASI) score being 69.6 (Table 1). GPPASI is calculated using the exact methodology as the psoriasis area and severity index (PASI) score, except the scale score is substituted with a score for pustules. By week four, the patient was ambulatory with an assistive device with a 79% improvement in the GPPASI score (Fig. 1). At week five, one week following his second gevokizumab injection, the study was discontinued due to a flank abscess, which required incision and drainage and systemic antibiotics. It was unlikely that the gevokizumab was directly related to the patient’s abscess formation, as the medication had significantly decreased the patient’s overall pustulosis. The most likely cause was a recent fall the patient had sustained at
This article is protected by copyright. All rights reserved. home that led to the formation of a small hematoma on his flank, which became a nidus for infection given the status of his skin’s barrier function. The patient is currently well controlled with occasional flares on a combination of adalimumab and acitretin. Patient 2 was a 59 year-old white female with a 6-month history of severe recalcitrant GPP, which had evolved from a prior diagnosis of localized palmoplantar pustulosis and who had no evidence of plaque psoriasis. She had previously failed etanercept, adalimumab, adalimumab with methotrexate, and cyclosporine. At study day zero, the BSA was 36% and the GPPASI score was 14.4 (Table 1). At week 12, a 65% reduction in GPPASI was achieved. Dermatology life quality index (DLQI) values indicated that her skin disease continued to have a large effect on her quality of life, as is commonly seen in patients with palmoplantar disease. In addition, our previously published palmoplantar life quality instrument6 indicated a total lack of ability to use her hands and feet. Given the continued impact of the disease on her quality of life, the patient elected to discontinue from the study and is currently moderately controlled on infliximab and methotrexate.
Discussion There is a considerable potential for the use of IL-1β inhibitors for treating conditions of widespread pustulosis followed the discovery of the deficiency in the IL-1 receptor antagonist (DIRA)7 and the subsequent analogous deficiency in the IL-36 receptor antagonist (DITRA) in familial GPP1. IL-1β inhibitors have shown efficacy in GPP and other pustular conditions, including cases of DIRA, DITRA, and palmoplantar pustulosis5, 7-10. Both our patients showed substantial initial clinical response to gevokizumab with no significant laboratory abnormalities
This article is protected by copyright. All rights reserved. noted. These two cases illustrate the growing need for targeted, safe, and efficacious therapies for this severe, debilitating disease. Prospective randomized control trials are required to assess the safety and efficacy of IL-1β inhibitors for the treatment of GPP.
Acknowledgements: We are indebted to Jennifer Whitmore, Rajneesh Nath, and Peter Foote of XOMA (US) LLC for their collaboration in this study. XOMA (US) LLC provided gevokizumab at no cost to the patients. The sponsor was involved in the design of the study, the review and approval of the manuscript, and the decision to submit the manuscript for publication.
References: 1. Marrakchi S, Guigue P, Renshaw BR, Puel A, Pei XY, Fraitag S et al. Interleukin-36-receptor antagonist deficiency and generalized pustular psoriasis. The New England journal of medicine 2011;365:620-8. 2. Sugiura K, Takemoto A, Yamaguchi M, Takahashi H, Shoda Y, Mitsuma T et al. The majority of generalized pustular psoriasis without psoriasis vulgaris is caused by deficiency of interleukin36 receptor antagonist. The Journal of investigative dermatology 2013;133:2514-21. 3. Robinson A, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Bebo BF, Jr. et al. Treatment of pustular psoriasis: from the Medical Board of the National Psoriasis Foundation. Journal of the American Academy of Dermatology 2012;67:279-88. 4. Viguier M, Aubin F, Delaporte E, Pages C, Paul C, Beylot-Barry M et al. Efficacy and safety of tumor necrosis factor inhibitors in acute generalized pustular psoriasis. Archives of dermatology 2012;148:1423-5.
This article is protected by copyright. All rights reserved. 5. Viguier M, Guigue P, Pages C, Smahi A , Bachelez H. Successful treatment of generalized pustular psoriasis with the interleukin-1-receptor antagonist Anakinra: lack of correlation with IL1RN mutations. Annals of internal medicine 2010;153:66-7. 6. Farley E, Masrour S, McKey J , Menter A. Palmoplantar psoriasis: a phenotypical and clinical review with introduction of a new quality-of-life assessment tool. Journal of the American Academy of Dermatology 2009;60:1024-31. 7. Aksentijevich I, Masters SL, Ferguson PJ, Dancey P, Frenkel J, van Royen-Kerkhoff A et al. An autoinflammatory disease with deficiency of the interleukin-1-receptor antagonist. The New England journal of medicine 2009;360:2426-37. 8. Tauber M, Viguier M, Alimova E, Petit A, Liote F, Smahi A et al. Partial clinical response to anakinra in severe palmoplantar pustular psoriasis. The British journal of dermatology 2014. 9. Rossi-Semerano L, Piram M, Chiaverini C, De Ricaud D, Smahi A , Kone-Paut I. First clinical description of an infant with interleukin-36-receptor antagonist deficiency successfully treated with anakinra. Pediatrics 2013;132:e1043-7. 10. Minkis K, Aksentijevich I, Goldbach-Mansky R, Magro C, Scott R, Davis JG et al. Interleukin 1 receptor antagonist deficiency presenting as infantile pustulosis mimicking infantile pustular psoriasis. Archives of dermatology 2012;148:747-52.
FIGURE 1 Legend: Clinical photographs of patient 1 with generalised pustular psoriasis at (a) week 0, (b) week 2, and (c) week 4 following one dose of gevokizumab.
This article is protected by copyright. All rights reserved. TABLE 1 Week BSA (%) GPPASI PGA DLQI
0 97 69.6 5 30
Patient 1 2 77 35.8 5 30
4 62 22.1 3 26
0 36 14.4 4 30
2 32 14.7 4 30
Patient 2 4 33 11.3 4 23
8 23.5 7.7 3 17
12 5.7 5.0 2 17
Abbreviations: PASI = psoriasis area and severity index, BSA = body surface area, GPPASI = generalized pustular psoriasis area and severity index, PGA = physician’s global assessment, DLQI = dermatology life quality index Legend: Quantitative clinical parameters for both patients over their respective courses of therapy.
