Treatment of two patients with generalized pustular psoriasis with the interleukin-1β inhibitor gevokizumab

Generalized pustular psoriasis (GPP) is a severe, potentially life-threatening inflammatory dermatosis, which is traditionally difficult to manage. Recent evidence suggests that interleukin (IL)-1 plays a central role in the disease pathogenesis, and thus makes the use of IL-1 inhibitors potentially effective. Two patients with severe, recalcitrant GPP were enrolled in an open-label, expanded access study to receive a new IL-1 beta inhibitor, gevokizumab. The two patients had a respective 79% and 65% reduction in GPP area and severity index scores at weeks 4 and 12, with some improvements in quality-of-life instruments. There were no significant adverse events related to the study medication, although one patient developed an abscess in a haematoma secondary to an injury. Both patients showed substantial initial clinical response to gevokizumab, with no significant laboratory abnormalities noted. These cases illustrate the growing need for targeted, efficacious therapies for this severe, debilitating disease. Prospective randomized control studies are required to further assess the safety and efficacy of IL-1 beta inhibitors for the treatment of GPP.