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Use of Systemic Biologics and Small Molecules in the Management of Generalized Granuloma Annulare
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- This evidence-based systematic review outlines data regarding therapies for generalized granuloma annulare. Complete resolution was most commonly noted with treatment with dupilumab, infliximab, baricitinib, tofacitinib, and adalimumab. Treatment with etanercept often resulted in minimal to no improvement. The mean treatment duration across all treatments was 125.5 days. Recurrence after initial resolution, despite continued treatment, occurred in 10% of the patients and was most likely to be noted among those treated with infliximab.
- This review highlights potential systemic agents that can be used to treat patients with generalized granuloma annulare. Ongoing clinical trials are investigating the use of tofacitinib and abrocitinib for the management of patients with generalized granuloma annulare.
abstract
This abstract is available on the publisher's site.
Access this abstract nowGeneralized granuloma annulare (GGA) is an immunemediated granulomatous condition with a recalcitrant disease course. To date, there remains no US FDA-approved therapy for GGA. This systematic review summarizes the evidence regarding targeted systemic biologic and small molecule modalities for GGA treatment.
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Journal of Cutaneous Medicine and Surgery
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Management of Generalized Granuloma Annulare Using Systemic Biologics and Small Molecules: An Evidence-Based Review
J Cutan Med Surg 2024 Oct 05;[EPub Ahead of Print], S Sood, A Bagit, A Sriranganathan, K Maliyar, M Sachdeva, A Abduelmula, Y Lytvyn, A Mufti, J YeungFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Generalized granuloma annulare (GGA) accounts for approximately 15% of all cases of granuloma annulare. GGA is characterized by widespread erythematous papules and/or annular plaques that are often located on the trunk and extremities. Although GGA is a benign condition, its appearance can be quite distressing to patients. Data on the pathophysiology of GGA are heterogeneous, and there are no FDA-approved treatments. Providers often struggle to choose from the dozens of off-label therapies that are reported in the literature, largely in the form of uncontrolled case reports or series.
This systematic review from Canada evaluated data regarding newer targeted treatments for GGA — ie, systemic biologics and small molecule inhibitors. A total of 45 articles met the inclusion criteria and included 85 patients whose demographics reflected those of cases previously reported in the literature (mean age, 59.6 years; males, 13.7%; females, 86.3%). Notably, 69.4% of the cases (59 of 85 cases) were refractory to conventional systemic therapy and/or phototherapy. Of the treatments reviewed, the most commonly used medications were TNF-α inhibitors (50% [50/100]; adalimumab, etanercept, infliximab, and golimumab) and JAK inhibitors (24% [24/100]; tofacitinib, baricitinib, upadacitinib, and abrocitinib). Complete resolution was most frequently observed with the IL-4/IL-13 inhibitor dupilumab (100.0% [3 of 3 cases]; mean duration, 51.3 days), infliximab (85.7% [6 of 7 cases]; mean duration, 335.8 days), baricitinib (80.0% [4 of 5 cases]; mean duration, 51.5 days), tofacitinib (72.7% [8 of 11 cases]; mean duration, 192.9 days), and adalimumab (68.8% [22 of 32 cases]; mean duration, 129.1 days). No severe adverse events were reported, and recurrence was observed in 10% of cases following treatment cessation (mean follow-up period of 9.1 months).
Larger-scale and randomized trials for the treatment of GGA are needed. However, this study provides evidence to support the use of emerging targeted treatments, namely, TNF-α inhibitors (infliximab and adalimumab), JAK inhibitors (baricitinib and tofacitinib), and dupilumab, for cases of GGA refractory to conventional therapies.