Partial clinical response to anakinra in severe palmoplantar pustular psoriasis

• Published in: British journal of dermatology (1951) Vol. 171; no. 3; pp. 646 - 649
• Main Authors: Tauber, M., Viguier, M., Alimova, E., Petit, A., Lioté, F., Smahi, A., Bachelez, H.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-09-2014; Oxford University Press
• Subjects: Aged; Dermatologic Agents - therapeutic use; Humans; Interleukin 1 receptor antagonist; Interleukin 1 Receptor Antagonist Protein - therapeutic use; Male; Middle Aged; Patients; Population studies; Psoriasis; Psoriasis - drug therapy; Quality of life; Treatment Outcome
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.13012

Summary
Background
Palmoplantar pustular psoriasis is a clinical psoriasis variant characterised by a high impact on quality of life and poor response to biologics approved for plaque type psoriasis.The recombinant interleukin‐1 (IL‐1) receptor antagonist anakinra has been recently used for the treatment of isolated refractory cases of generalised pustular psoriasis with contrasted results.
Objectives
To report the clinical response in two patients treated with anakinra as salvage therapy in two patients with severe palmoplantar pustular psoriasis refractory to currently available antipsoriatic systemic therapies.
Methods
Anakinra was given subcutaneously at the daily dose of 100 mg, and clinical response was evaluated using the palmoplantar psoriasis area and severity index (PPPASI).
Results
Only partial and transient responses were observed in both patients, who had to stop anakinra due to lack of efficacy and to side effects.
Conclusion
Anakinra appears to provide only partial clinical improvement in refractory palmoplantar pustular psoriasis. Prospective clinical studies on larger populations are warranted to investigate more accurately both efficacy and safety of IL‐1‐inhibiting strategies in pustular psoriasis.
What's already known about this topic?
Palmoplantar pustular psoriasis (PPPP) is a chronic inflammatory skin disease known to be refractory to currently available therapeutics.
Anakinra is a recombinant form of interleukin‐1 receptor antagonist (IL‐1Ra) labelled for the treatment of rheumatoid arthritis and commonly used in DIRA syndrome (deficiency in IL‐1Ra).
What does this study add?
We report two cases of PPPP managed with anakinra.
Anakinra may provide transient alleviation of skin inflammation in PPPP, without complete remission.