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GPP flares: pronounced undertreatment is common

Presented by
Dr Wendell Valdecantos , Boehringer Ingelheim Pharmaceuticals, CT, USA
SPIN 2022
According to a US retrospective analysis of healthcare records from 2015 to 2020, a quarter of patients with general pustular psoriasis (GPP) flares receive no treatment at all. Despite severe and potentially life-threatening symptoms, many patients were only treated with pain medication and topical steroids.

Due to the rareness and unpredictability of GPP flares, only minimal research documenting the characteristics of these events has been performed. “Therefore, our study aimed to characterise flare episodes in GPP patients and respective treatments,” said Dr Wendell Valdecantos (Boehringer Ingelheim Pharmaceuticals, CT, USA), who presented the study [1].

This retrospective descriptive study included adult patients with GPP (ICD-10 code L40.1) identified in US electronic health record (EHR) data between 1 July 2015 and 30 June 2020. Only patients with at least 12 months of healthcare activity documented in the EHR after the GPP diagnosis and with notes available were included. An algorithm identified flare episodes based on diagnosis coding, setting of care, type of provider, GPP disease terms, and flare terms found in the EHR. Flare episodes were defined as consecutive days that a flare was documented in the records and were characterised by the frequency of occurrence per patient, the setting of care where they were identified, the type of specialist managing the episode, associated symptoms, and the treatments before, during, and after the episode.

Of the 48.6 million patients with EHR notes available, 1,535 patients with GPP were identified. Of these, 271 patients had at least 1 flare episode documented in their records and accounted for 513 flare episodes during the study period. More than 80% were Caucasian. Most flares occurred in the outpatient setting (57%), followed by inpatient and emergency room settings. Most flares occurred 1 month after an initial GPP diagnosis. As Dr Valdecantos pointed out, “87% of patients had flares identified on the same day they got the diagnosis.” Various treatments were used: most commonly, both during the episode (in 35% of cases) and up to 30 days prior to an episode (in 22% of cases), were topical steroids, followed by opioids and other oral agents. “Of note, 21% of patients were using opioids for flare episodes, and 25% were not receiving any treatment during the episode and up to 30 days after,” Dr Valdecantos commented.

Despite the limitation of a retrospective study, this data shows a significant unmet need for the treatment of GPP flares, as evidenced by patients seeking treatment in inpatient and especially emergency room settings and the lack of advanced therapies beyond topical steroids. “Lastly, treatment with opioids was common during flare episodes, indicating the need for pain management,” Dr Valdecantos concluded.

  1. Zema CL, et al. Characteristics and treatment of generalised pustular psoriasis (GPP) flares in the US. FS 8, SPIN 2022 Congress, 06–08 July, Paris, France.


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