Higher Mortality for Generalized Pustular Psoriasis Compared With Plaque Psoriasis Highlights the Need for Improved Treatments: Insights From a Meta-Analysis
Author(s)
Bruce Strober, MD, PhD1, Luís Puig, PhD2, Mark G. Lebwohl, MD3, Bhargav Lakshminarasimhan, PharmD, MBA4, Shah Alam Khan, MBBS, MS4, Nichiren Pillai, MSc, MBA4, Bregt Kappelhoff, PharmD, PhD4, Amy Weatherill, PhD5, Richard B. Warren, MBChB (Hons), PhD6.
1Department of Dermatology, Yale University, New Haven, and Central Connecticut Dermatology, Cromwell, CT, USA, 2Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 3Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA, 4Boehringer Ingelheim International GmbH, Ingelheim, Germany, 5Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA, 6Dermatology Centre, Northern Care Alliance NHS Foundation Trust & Division of Musculoskeletal and Dermatological Sciences Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
1Department of Dermatology, Yale University, New Haven, and Central Connecticut Dermatology, Cromwell, CT, USA, 2Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 3Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA, 4Boehringer Ingelheim International GmbH, Ingelheim, Germany, 5Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA, 6Dermatology Centre, Northern Care Alliance NHS Foundation Trust & Division of Musculoskeletal and Dermatological Sciences Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
OBJECTIVES: Generalized pustular psoriasis (GPP) is a chronic, systemic inflammatory disease, which is associated with flares and life-threatening complications. This study compared GPP mortality with that for plaque psoriasis and the general population.
METHODS: Studies reporting mortality data for GPP and plaque psoriasis/the general population were selected for inclusion in meta-analyses through a systematic literature review and review of unpublished data. The quality of each study was assessed using the Newcastle-Ottawa Scale. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for mortality risk for GPP versus plaque psoriasis and the general population. Sensitivity analyses evaluated the robustness of the primary results.
RESULTS: Of 38 studies reporting GPP mortality, four (all observational) satisfied the eligibility criteria for the meta-analyses. Primary meta-analyses included two studies (Sweden and the USA) representing 3,652 patients with GPP. Mortality was significantly higher for GPP versus plaque psoriasis (HR: 1.78; 95% CI: 1.52-2.09; P<0.0001) and the general population (HR: 2.92; 95% CI: 1.12-7.60; P=0.03). Two additional studies (France and Germany) were included in a sensitivity analysis for GPP (n=6,470) versus plaque psoriasis and the results supported the primary analysis (HR: 2.23; 95% CI: 1.43-3.49; P=0.0004). The sensitivity analysis for GPP versus the general population, which included one additional study (Germany; total GPP n=4,628), indicated that mortality was not significantly higher for GPP (HR: 1.63; 95% CI: 0.45-5.97; P=0.46). The German study had a HR of 0.47 (95% CI: 0.27-0.84) but with known miscoding issues (Schultze et al. J Dtsch Dermatol Ges 2025 DOI: 10.1111/ddg.15633).
CONCLUSIONS: The all-cause mortality risk was approximately 2-3 times higher for GPP compared with plaque psoriasis and the general population. This highlights the imminent need to prevent future GPP flares and chronic complications associated with increased risk of mortality through targeted long-term treatments.
METHODS: Studies reporting mortality data for GPP and plaque psoriasis/the general population were selected for inclusion in meta-analyses through a systematic literature review and review of unpublished data. The quality of each study was assessed using the Newcastle-Ottawa Scale. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for mortality risk for GPP versus plaque psoriasis and the general population. Sensitivity analyses evaluated the robustness of the primary results.
RESULTS: Of 38 studies reporting GPP mortality, four (all observational) satisfied the eligibility criteria for the meta-analyses. Primary meta-analyses included two studies (Sweden and the USA) representing 3,652 patients with GPP. Mortality was significantly higher for GPP versus plaque psoriasis (HR: 1.78; 95% CI: 1.52-2.09; P<0.0001) and the general population (HR: 2.92; 95% CI: 1.12-7.60; P=0.03). Two additional studies (France and Germany) were included in a sensitivity analysis for GPP (n=6,470) versus plaque psoriasis and the results supported the primary analysis (HR: 2.23; 95% CI: 1.43-3.49; P=0.0004). The sensitivity analysis for GPP versus the general population, which included one additional study (Germany; total GPP n=4,628), indicated that mortality was not significantly higher for GPP (HR: 1.63; 95% CI: 0.45-5.97; P=0.46). The German study had a HR of 0.47 (95% CI: 0.27-0.84) but with known miscoding issues (Schultze et al. J Dtsch Dermatol Ges 2025 DOI: 10.1111/ddg.15633).
CONCLUSIONS: The all-cause mortality risk was approximately 2-3 times higher for GPP compared with plaque psoriasis and the general population. This highlights the imminent need to prevent future GPP flares and chronic complications associated with increased risk of mortality through targeted long-term treatments.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH126
Topic
Epidemiology & Public Health
Disease
Sensory System Disorders (Ear, Eye, Dental, Skin)