Generalized Pustular Psoriasis Confers Higher Disease Burden Than Plaque Psoriasis

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The characteristics and burden of disease in patients with generalized pustular psoriasis compared with those with plaque psoriasis are reviewed.

Generalized pustular psoriasis (GPP), a rare yet severe systemic skin disease, is associated with greater healthcare resource utilization and an increased comorbidity burden compared with plaque psoriasis, according to findings from a retrospective study of Japanese patients with GPP and plaque psoriasis published in the Journal of Dermatology.

The study included data from an acute hospital-based claims database in Japan which comprised inpatients and outpatients with GPP (n=718; mean age, 60.9 years; men, 48.5%) and plaque psoriasis (n=27,773; mean age, 62.9 years; men; 61.3%). Another general population-matched cohort of 2867 people without GPP or psoriasis (mean age, 60.9 years; men, 48.4%) was also included.

Patients were included in 12-month follow-up analyses. During these analyses, researchers compared the groups in regard to the prevalence of comorbidities, medication use, and healthcare resource utilization.

Patients with GPP were significantly more likely to have comorbidities compared with patients with plaque psoriasis. The most common comorbidities in patients with GPP vs plaque psoriasis and the matched control group were psoriatic arthritis (12.9% vs 3.6% and 0.0%, respectively), other types of psoriasis (6.0% vs 3.9% and 0.0%), peptic ulcer disease (27.0% vs 20.7% and 10.0%), osteoporosis (22.1% vs 12.8% and 5.7%), and interstitial pneumonia (8.1% vs 4.7% and 1.1%).

Compared with patients with plaque psoriasis, those with GPP were also more likely to receive topical steroids, nonbiologic systemic, or biologic therapies (79.7% vs 88.4%) over the 12-month follow-up period.

A lower percentage of patients with GPP were treated with topical steroid monotherapy compared with patients with plaque psoriasis (14.0% vs 42.0%, respectively), and a higher percentage of patients with GPP received topical steroids and concomitant nonbiologic systemic therapy (42.3% vs 23.9%).

Patients with GPP were also more likely to receive additional medications for comorbidities compared with the plaque psoriasis cohort and the matched control group. These additional medications included antihypertensive agents, psychiatric medications, antibiotics, and nonbenzodiazepine agents.

Those with GPP had a higher mean number of outpatient visits during the study period compared with the plaque psoriasis and matched control groups (mean, 15.7 vs 13.8 and 7.5 visits, respectively). Patients with GPP also had greater inpatient hospitalizations lasting more than 24 hours in duration (35.5% vs 23.0% and 11.6%).

In addition, patients with GPP had significantly higher all-cause hospitalization costs (mean, ¥1.67 million for GPP vs ¥868.7K for plaque psoriasis and ¥292.0K for matched cohort).

Limitations of this study included its retrospective design as well as the exclusion of patients who had received care outside the study-specific hospital system, likely affecting the generalizability of the results.

The investigators of the study wrote they hope the findings “will reinforce the need for a distinct treatment and management pathway for patients with GPP and will encourage the further development of disease management practices for patients with GPP.”

Disclosure: This clinical trial was supported by Boehringer Ingelheim. Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Morita A, Kotowsky N, Gao R, Shimizu R, Okubo Y. Patient characteristics and burden of disease in Japanese patients with generalized pustular psoriasis: Results from the Medical Data Vision claims database. J Dermatol. Published online July 1, 2021. doi:10.1111/1346-8138.16022