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Use of Combination Therapy in GPP


Drs Raj Chovatiya and Boni Elewski comment on the future of combination therapy in GPP, highlighting spesolimab.

Raj Chovatiya, MD, PhD: Yeah, I think the question here is, and we probably just don't have enough data to answer it, in dermatology, we love combining treatments and putting things together. In the case of spesolimab, obviously, has not necessarily been studied in combination with other systemic therapies and other things as well. And so, I think that it'll be interesting, as we have more and more availability over the next year from what types of things people are doing for somebody that might be on a longstanding therapy. But then adding this on top of that or some type of combination. I wouldn't view topicals really, that's probably a pretty benign combination, but in terms of systemics, I wonder if that's something that's going to come into play in the future.

Boni Elewski, MD: I do have my patient that I mentioned earlier who has been on infliximab for 20 years and I'm trying to get him spesolimab. My plan is to have him on both for a while. I just am working on through the insurance process, get him an infusion, because he still has pustules and he is still miserable. So, it's not curing him, he's not at target at all, but he is better. He's able to function and he is able to work. He's still quite miserable, however, and he can't even take methotrexate that often because he has problems with his liver.

Raj Chovatiya, MD, PhD: I think that's probably the direction I would take, too, for somebody that's on longstanding therapy. The science hasn't necessarily caught up to it, but like you and I were saying that for somebody that maybe does have plaque psoriasis or psoriatic arthritis in addition to pustular psoriasis probably has activation of multiple pathways. And so blocking 12, 23, TNF-17, probably, does not effectively block 36 and vice versa. So, there just might be patients that require longitudinal therapy with 1 more conventional agent to then sort of intermittent use of something to block the actual dysregulated IL-36 that may occur in spurts. So, this is me just kind of spit balling the immunology here, but I look forward, as we sort of get more and more cases out there, really what's happening in the real world when it comes to spesolimab because, make no question, I think that, even though this is not the most common condition, [spesolimab is] really a game-changing medication for a condition where, as you really nicely told us for the patients you've managed over the years, your option list was very, very short.

Transcript edited for clarity.

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