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Reducing the Hospital Stay for Patients With GPP


Aaron Farberg, MD, and Mark G. Lebwohl, MD, explore the typical hospital length of stay for patients with an acute generalized pustular psoriasis (GPP) flare, and define treatment success with GPP therapies.

Ryan Haumschild, PharmD, MS, MBA: Dr Farberg, if I can look to you, what is a typical length of stay for someone with an acute generalized pustular psoriasis [GPP] flare? And how does the medication that has the potential to resolve the pustulation we’ve talked, about maybe an IL-36 [interleukin-36] inhibitor, within a week, how does that impact the course of this type of disease? Talk us through that because I think that helps us give more cost considerations around urgent approvals, urgent precertification in the outpatient setting vs inpatient.

Aaron Farberg, MD: Of course, every patient is different, and you’ll have anecdotes of shorter stays or longer stays, but when you have a patient who’s walking in the door and they’re that sick, you already know that they’re going to be spending at least a couple of weeks in the hospital. Hopefully not the ICU [intensive care unit], but you’ve heard some of the data, and the numbers don’t lie. Usually, at least a few, if not several days, to more than a week in an ICU. We know how important those beds and the intensity of that care truly are. You’re looking at a couple of weeks to potentially even longer. What’s fantastic is you’ve heard from the clinical trials data and the clinical experiences Dr Lebwohl has shared from [Boni] Elewski, [MD,]—by the next day, with the approved medication spesolimab, you’re having a significant impact. And the studies are where you can really see this. In 1 week, more than half of them are clear. This is fantastic.

Hearing Dr Lopes talk about how we can all partner together, it makes a lot of sense, recognizing we’re all on the same team here, focused on getting these patients better as quickly as possible. It’s really nice to know that we have 1 FDA-approved treatment, and we also know from the studies how quickly it works. To put the numbers on it, you’ve got a several week stay down to patients most likely clearing by the end of a week and going home.

Ryan Haumschild, PharmD, MS, MBA: As we think about treatment success for generalized pustular psoriasis, what outcomes are we looking for? Dr Lebwohl, I’m going to turn to you because we’ve talked about a lot of things, reducing the hospitalization, providing a shorter course of disease for patients, reducing layers, improving quality of life. But at the end of the day, how do we define success for GPP therapies?

Mark G. Lebwohl, MD: I think taking them out of that danger zone as quickly as possible is the single most important thing we do. The second thing is restoring a normal skin, normal life as quickly as we can.

Ryan Haumschild, PharmD, MS, MBA: Tell me a little more, do you utilize the Generalized Pustular Psoriasis Physician Global Assessment when you’re monitoring these patients? Is that something you look to in your clinical practice, or are there other things you look at besides that tool?

Mark G. Lebwohl, MD: I think it’s a good tool in clinical trials. Nobody uses it in practice. By the way, some of the old studies use PASI [Psoriasis Area and Severity Index]scores. That’s almost ridiculous because these pustules are not thick, and thickness of the plaque is one of the measures of a PASI score. The GPP PASI is a better score. The pustulation score is to me the best score. That’s something that’s right in front of your eyes, and you don’t have to think about it, you can see it. One day they’re there, the next day they’re gone. Again, restoring the patient to normal is an important goal and something that finally is possible.

Transcript edited for clarity.

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