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Use of Biologic Therapies in the Management of Patients With Pyoderma Gangrenosum
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- This systematic review assessed the use of biologic therapies in the management of patients with pyoderma gangrenosum (PG). The results showed that the most utilized biologic therapies were infliximab, adalimumab, and etanercept. Overall, 88.9% of the patients achieved complete resolution with biologic therapies, with PG recurring in only 15.5% of the cases. The average time for the patients to show improvement in their PG was 30 days, and the average time for patients to achieve complete resolution was 161 days.
- This review showed that biologic therapies were effective for the treatment of patients with pyoderma gangrenosum, with nearly 90% of those receiving biologics achieving complete resolution.
abstract
This abstract is available on the publisher's site.
Access this abstract nowTreatment of pyoderma gangrenosum (PG) is challenging due to the absence of standardized guidelines and the lack of evidence-based, effective treatment options. Here, we performed a systematic review to summarize the use of biologics and their efficacy in the treatment of PG. We searched PubMed/MEDLINE, EMBASE, and Cochrane electronic databases from their inception to September 22nd, 2022, and included 82 peer-reviewed studies with a total of 108 patients. Infliximab, adalimumab, and etanercept were the most utilized biologic therapies in the treatment of PG in 64.8% (70/108), 16.7% (18/108), and 11.1% (12/108) of the cases, respectively. With respect to treatment response, 88.9% (96/108) of the patients achieved complete resolution of PG with biologic therapies. The average number of days to improvement and resolution of PG treated after starting biologic therapies was 30 and 161, respectively. PG recurred in 15.5% (11/71) of those reported the outcome. Our study suggests that biologic therapies may be an attractive therapeutic option for PG with an excellent efficacy.
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Use of biologic therapies in the management of pyoderma gangrenosum: a systematic review
Arch Dermatol Res 2024 Aug 19;316(8)539, M Zaman, R Martinez, O Mayur, M Montoya, G Serwald, MC McNichol, JS McGeeFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The use of biologic therapy in the treatment of pyoderma gangrenosum (PG) has been an active area of exploration, especially gaining momentum over the past 5 years with the diversification of available biologics in the market. The rarity of PG contributes to the limited high-quality prospective trial data supporting the use of any specific biologic for the treatment of the disease, and the condition has, therefore, primarily appeared in the literature as one-off case reports, short case series, or — in the case of the article being discussed herein — systematic reviews.
Overall, the data in this article are in line with those from other systematic reviews or "semi-systematic reviews" on the same topic, with TNF-α inhibitors representing the majority of the utilized biologics (64.8%). As mentioned by the authors, the TNF-α inhibitor infliximab remains one of the few biologics studied in placebo-controlled trials specifically for use in patients with PG.1 More recently, adalimumab was approved in Japan in 2020. It is understandable that the existence of cumulative evidence in the hands of dermatologists favors the selection of TNF-α inhibitors for patients with PG.
The main challenges of comparing the cumulative evidence of efficacy for clinical trials in PG are related to the lack of standardization of outcome measures. UPGRADE (ie, Understanding Pyoderma Gangrenosum: Review and Analysis of Disease Effects) is an international initiative that was created in 2020 to lead outcome research in PG where all stakeholders worldwide collaborate towards establishing an international consensus of a core outcome set for PG clinical trials. This effort has already made an impact, as eight studies in phase II and phase III are being or planned to be conducted for PG since UPGRADE was founded. The same number of studies were implemented 16 years before 2020. After over 100 years since being first reported by Dr. Louis-Anne-Jean Brocq in 1916, the future is brighter for patients suffering from this horrendous disease.
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