OBJECTIVES: Literature describing the mortality burden of generalized pustular psoriasis (GPP) in the United States (US) is limited. This study compared all-cause mortality among patients with GPP with matched populations of patients with plaque psoriasis (PsO), and the general population without GPP or plaque PsO.

METHODS: Five cohorts (GPP only, Plaque PsO only, Comorbid GPP+plaque PsO, All GPP, and General population) were constructed from Inovalon Insights real-world claims data (January 1, 2016 to December 31, 2019). All-cause mortality was assessed at 365-day post-index diagnosis and maximum follow-up. Greedy caliper propensity score matching was used to match GPP patients 1:2 to the Plaque PsO only and General population cohorts using index year, age, sex, insurance type, region, and Charlson Comorbidity Index. All-cause mortality risk was assessed using Cox proportional hazard models.

RESULTS: At 365-day follow-up, mortality risk was significantly higher in the All GPP cohort vs the General population (hazard ratio [HR] 4.93, 95% confidence interval [CI] 2.24, 10.88) and Plaque PsO only cohorts (HR 2.31, 95% CI 1.32, 4.04). The GPP+plaque PsO cohort had a significantly higher mortality risk than the Plaque PsO only cohort (HR 2.67, 95% CI 1.15, 6.20). At maximum follow-up, mortality risk for the All GPP cohort was ~4 times higher than the General population (HR 3.98, 95% CI 2.92, 5.43) and 1.5 times higher than the Plaque PsO only cohort (HR 1.49, 95% CI 1.20, 1.85). In the GPP+plaque PsO and GPP only cohorts, mortality risk was ~1.5 times higher than in the Plaque PsO only cohort (HR 1.41, 95% CI 1.05, 1.90; HR 1.49, 95% CI 1.10, 2.03); all comparisons at maximum follow-up were statistically significant.

CONCLUSIONS: Patients in the US with GPP demonstrated a higher risk of mortality in GPP compared with the matched PsO and General population cohorts.