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Case 2 Presentation: 58-Year-Old Woman With GPP

Opinion
Video

Erin Boh, MD, emphasizes the importance of patient empowerment and physician education surrounding the management of GPP.

Mark Lebwohl, MD: The patient I’m presenting is a 58-year-old woman who was in good health. She did not know she had a diagnosis of psoriasis. She developed joint pains and saw a rheumatologist who diagnosed her with presumed rheumatoid arthritis and treated her with hydroxychloroquine. Two weeks later, she developed a generalized eruption characterized by erythema and covered with pustules, with many of the pustules becoming confluent to form lakes of puss. She was then treated with prednisone but ultimately could not clear her pustular psoriasis. She saw several physicians before the correct diagnosis was made. She was then treated with spesolimab, which resulted in rapid resolution.

In many institutions, spesolimab is given in an infusion unit, and it is at Ichan School of Medicine Mount Sinai in New York, New York. One of the first patients we had to treat with it, though, had no insurance. The charge of the infusion unit was going to be exorbitant and the patient couldn’t afford it, so we simply got an IV [intravenous] pump on our floor, started an IV, and administered it by infusion in our practice suite. It went very smoothly.

It is not one of the drugs that causes hypotension or acute infusion reactions that we see with some of the other drugs we use, including infliximab, which we have been given intravenously in our office. I would say it’s a pretty easy drug to administer, but if you don’t want to administer it in your own practice, there are commercial infusion units across the country that will happily administer this for you. I would encourage you to contact one of those or go to your local hospital where they infuse medications. It’s very easy to get the drug that way.

Erin Boh, MD: Yeah, and most of the time it’s easy to infuse. It’s a very short infusion time, and most of the infusion centers are willing to do it. At this point in time, the insurance carriers favor doing it at a nonhospital-based infusion center. But again, if your patient is medically unstable like mine, you need to push for the inpatient setting. But it’s a very easy drug to administer. As I said, it’s given over a very short period of time. The original studies to get the drug approved did not use anything for premedication.

If you are used to doing infusions like many of us are, we will often premedicate with acetaminophen and Benadryl [diphenhydramine]. Neither one of those were recommended to be given in part because, during the study time some of the patients may have had a drug rash and they didn’t want to confound the study. So, premedication was not, given. When we did ours, we did not premedicate at all. We did not give IV fluids beforehand. You just do it as an IV drip, and it’s a small volume. In patients who are fluid overloaded already, it doesn’t add much to it; it’s done relatively quickly and then the patients go home. It’s one that’s easy to do and one that has very little in the way of post infusions, adverse effects like you might see with things like either IVIG [intravenous immunoglobulin], rituximab, or anything like that.

Mark Lebwohl, MD: Thank you for watching this Dermatology Times® Around the Practice program. If you enjoyed this conversation, please subscribe to our e-newsletters to receive upcoming programs and other great content right in your inbox.

Transcript Edited for Clarity

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