Real-world clinical characteristics and treatment patterns of generalized pustular psoriasis flares.

Background: Clinical characteristics and treatment of generalized pustular psoriasis (GPP) flares are poorly understood.

Objective: To characterize patients by GPP flare status, quantify flare timing/frequency, and understand peri-flare treatment patterns.

Methods: This cohort study utilized electronic health records (2017-2023) from outpatient dermatology clinics in the OMNY Health real-world data platform. Patients were indexed at first GPP diagnosis code; encounter-level GPP flare status was established from previously developed algorithms. Annualized flare rate, time between flares, and peri-flare treatment patterns were described.

Results: Four hundred four of 638 patients (63%) experienced ≥1 flare episode. Patients who experienced a flare were more likely to be female, younger, nonwhite, Hispanic/Latino, have infectious/parasitic disease history, and more active GPP. Mean (median) annualized flare rate was 0.91 (0.51) flares/patient/year; mean (median) time between flares was 5.9 (3.8) months. Prescriptions increased from preflare period to flare episode, then decreased during the postflare period. Frequent treatment alterations of off-label biologics and nonsteroidal systemic agents were observed.

Conclusions: Data were from US-based outpatient dermatology practices; documentation of GPP flares may not have been comprehensive or consistent in this setting. Conclusions: GPP patients continue to experience frequent flares with traditional off-label therapies. Patients' course of treatment was altered frequently, suggesting an unmet need for effective long-term GPP therapies.