Secukinumab Demonstrates Long-Term Safety and Efficacy in Pediatric Patients with GPP

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A real-world study evaluated the long-term efficacy and safety of IL-17A inhibitor, secukinumab in pediatric patients with generalized pustular psoriasis (GPP).¹ Clinical outcomes and quality of life were improved over multiple time points with reduced flare frequency and no serious adverse effects.

The single-center, longitudinal retrospective study took place from July 1, 2021, to July 15, 2024, at Kunming Children’s Hospital. It included 10 pediatric patients, 7 male and 3 female. Participants aged 5 months to 3 years received 75 mg of secukinumab and those between the ages of 5 and 9.8 years were dosed with 150 mg. The therapy was administered via subcutaneous injection at weeks 0, 1, 2, 3, and 4 with maintenance every 4 weeks thereafter. The follow-up period lasted up to 160 weeks.

Clinicians measured disease severity and results with the Generalized Pustular Psoriasis Area and Severity Index (GPPASI), Japanese Dermatological Association (JDA) score, and Infants’/Children’s Dermatology Life Quality Index (IDLQI/CDLQI). They also tracked changes in body surface area of the affected skin and used Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) scores. Disease recurrence was defined as either a GPPGA pustular score of ≥2 or an increase of ≥2 in the GPPGA score.

Just at week 1, all patients had a rapid, positive response with GPPASI scores of 50 and mild JDA scores. At this mark, 10% reached GPPASI-90 and 50% reached GPPASI-75. By week 2, 8 patients achieved GPPASI-100 while 9 reached JDA scores of 0/1. At the 4-week follow-up, 90% of participants had near-complete or complete recovery. Between weeks 12 and 70, all participants maintained a GPPASI of 100 and a JDA score of 0, demonstrating sustained efficacy.

Some flare-ups did occur during the 75-160 week treatment period. By week 72, 2 of the 10 patients experienced flares. In the younger group, 3 out of 5 patients had recurrences while only 1 child in the older group had a recurrence, which occurred 89 weeks after the first dose. The investigators closely monitored progression and resolution, adjusting the medication regimen if necessary.

“Given the dynamic nature of a child’s growth and development, these dosages and intervals may require periodic adjustments,” the authors noted. “Consistent monitoring of efficacy, safety, and potential developmental impacts is essential to ensure that treatment remains both effective and safe over time.”

Quality of life for both patients and their families was improved throughout the trial. More specifically, the mean IDLQI/CDLQI improved from 21.8 at baseline to 0.4 by week 4. Scores temporarily increased after recurrences occurred, but this was to be expected.

Mild adverse effects such as local injection site reactions, pulpitis, conjunctivitis, suppurative otitis media, and upper respiratory symptoms, occurred in 5 patients. These did not lead to secukinumab discontinuation, and no serious adverse events occurred.

One key limitation of this trial is the single-center design and thus, the small sample size. To confirm clinical findings and develop more robust treatment guidelines, future studies should include a larger number of diverse participants via a multicenter, prospective design that extends the follow-up period even further.

Due to the high risk of comorbidities and complications associated with chronic and resistant GPP, safe, long-term treatment and sustained disease control is greatly needed.² Although there is data confirming the safety and efficacy of secukinumab in adult patients, the existing research surrounding vulnerable pediatric patients is sparse, especially over a long-term period.

“This research fills a crucial gap in the existing literature, offering profound insights into the application of secukinumab for pediatric GPP,” the authors wrote. “We anticipate that our findings will contribute significantly to the development of more efficacious and safe treatment strategies for this particularly vulnerable patient population.”

References

1. Xing L, Long L, Wu T, et al. Long-Term efficacy and safety analysis of secukinumab in the treatment of pediatric generalized pustular psoriasis: a real-world study. J Dermatolog Treat. 2025;36(1):2443121. doi:10.1080/09546634.2024.2443121

2. Navarini AA, Burden AD, Capon F, et al. European consensus statement on phenotypes of pustular psoriasis. J Eur Acad Dermatol Venereol. 2017;31(11):1792-1799. doi:10.1111/jdv.14386