Boehringer Ingelheim's spesolimab, now branded as Spevigo, has received FDA approval as the first treatment for generalized pustular psoriasis (GPP), a rare and life-threatening skin disorder. This approval marks a significant advancement for patients who previously lacked specific treatment options for managing GPP flares.
The approval is based on data from the EFFISAYIL 1 trial, a phase 2 study that evaluated the efficacy and safety of a single intravenous dose of spesolimab compared to placebo in 53 patients experiencing a GPP flare. The study included patients with a high or very high density of pustules on their skin.
Efficacy of Spesolimab
One week after administration, 54% of patients treated with spesolimab showed no visible pustules, compared to only 6% of those receiving placebo. This protective effect was sustained for up to 12 weeks, demonstrating the drug's potential to provide rapid and lasting relief from GPP flares. Mark Lebwohl of the Icahn School of Medicine at Mount Sinai, the lead investigator for the EFFISAYIL 1 trial, hailed the approval as a "turning point" for GPP patients and clinicians.
The Burden of GPP
GPP is characterized by eruptions of painful blisters that can lead to hospitalization and severe complications such as heart failure, renal failure, and sepsis. Mortality rates following GPP flares range from 2% to 16%, with septic shock and cardiorespiratory failure being the primary causes of death. Currently, off-label use of TNF, IL-17, and IL-23 inhibitors is sometimes employed, but with limited evidence of efficacy.
Ongoing Research and Future Directions
Boehringer Ingelheim is conducting further studies to explore the potential of spesolimab in GPP management, including the EFFISAYIL-2 trial, which is investigating its use as a maintenance treatment to prevent GPP flares, and the EFFSAYIL-ON, a five-year extension study assessing the long-term efficacy and safety of the antibody. Spesolimab is also being evaluated for the treatment of other skin diseases, such as palmoplantar pustulosis and hidradenitis suppurativa.
While Boehringer Ingelheim leads the way with the first approved GPP treatment, AnaptysBio is also developing an IL-36 inhibitor called imsidolimab, which is currently in the phase 3 GEMINI-1 study for GPP. Results from this study are expected in the fourth quarter of 2023.
