Clinical advances in biological therapy for generalized pustular psoriasis: a review.

The approval of spesolimab for GPP flare treatment marks a new era. However, whether spesolimab will be placed as the treatment of choice remains unknown considering its higher cost, lack of direct comparison with existing biologics and uncertain effects on co-existing plaque type psoriasis. However, the demonstration of numerically better efficacy for patients carrying pathogenic IL36RN mutations suggests the role of pharmacogenetics in the choices of GPP treatment. Future randomized studies are warranted to investigate effectiveness and safety of biologics for GPP in pediatric and pregnant groups.