Beatriz Butrón‐Bris

Background: Prediction of the response to a biological treatment in psoriasis patients would allow efficient treatment allocation.Objective: To identify polymorphisms associated with secukinumab response in psoriasis patients in a daily practice setting.Methods: We studied 180 SNPs in patients with moderate‐to‐severe plaque psoriasis recruited from 15 Spanish hospitals. Treatment effectiveness was evaluated by absolute PASI ≤3 and ≤1 at 6 and 12 months. Individuals were genotyped using a custom Taqman array. Multiple logistic regression models were generated. Sensitivity, specificity and area under the curve (AUC) were analysed.Results: A total of 173 patients were studied at 6 months, (67% achieved absolute PASI ≤ 3 and 65% PASI ≤ 1) and 162 at 12 months (75% achieved absolute PASI ≤ 3 and 64% PASI ≤ 1). Multivariable analysis showed the association of different sets of SNPs with the response to secukinumab. The model of absolute PASI≤3 at 6 months showed best values of sensitivity and specificity. Four SNPs were associated with the capability of achieving absolute PASI ≤ 3 at 6 months. rs1801274 (FCGR2A), rs2431697 (miR‐146a) and rs10484554 (HLCw6) were identified as risk factors for failure to achieve absolute PASI≤3, while rs1051738 (PDE4A) was protective. AUC including these genotypes, weight of patients and history of biological therapy was 0.88 (95% CI 0.83–0.94), with a sensitivity of 48.6% and specificity of 95.7% to discriminate between both phenotypes.Conclusion: We have identified a series of polymorphisms associated with the response to secukinumab capable of predicting the potential response/non‐response to this drug in patients with plaque psoriasis.

Generalised pustular psoriasis is a rare, unpredictable, and sometimes severe subtype of psoriasis whose treatment is hampered by a lack of consensus and standardised therapeutic guidelines. The recent recognition of the involvement of the innate interleukin (IL)‐1/IL‐36 pathway has allowed the development of new biologic drugs such as Spesolimab. We present the case of a woman with persistent generalised pustular psoriasis (GGP) who, after numerous failures with several systemic and biologic therapies, was treated with Spesolimab and showed a very rapid and sustained response over time.