Table 2.

Pustular palmoplantar psoriasis, efficacy and safety of biologic agents

Reference, type of study	Number of subjects	Treatment	Treatment duration	Outcome	Safety/comments
Adalimumab
Ghate 2009 [24], case report	1	Adalimumab 40 mg SC q 2 weeks	6 months	At week 16, BSA decreased from 4 to 1%, resolution of PsA symptoms; 8 months after d/c, no joint symptoms or PP	No SAEs reported; mild, diffuse scalp alopecia (leading to d/c at 6 months)
Etanercept
Ahmad 2007 [27], case series	1 (subset of 49 psoriasis patients)	Etanercept 25 mg or 50 mg SC BIW	Total mean 58.2 weeks	Failed	Unclear
Floristan 2011 [28], case report	1	Etanercept 0.4 mg/kg SC BIW for 8 months increased to 0.6 mg/kg SC BIW	12 months	Slow but progressive improvement over first month; at 12 months “striking improvement” of plantar lesions	No AEs reported
Kitamura 2009 [30], case report	1	Etanercept 50 mg SC BIW + efalizumb 80 mg weekly	≥ 11 months	Psoriasis and PsA “very well- controlled” (but pustular PP not responsive to etanercept alone)	1 SAE: reactivation TB
Infliximab
Kamili 2011 [35], case series	6 (subset of 120 psoriasis patients)	Infliximab 5 mg/kg IV at weeks 0, 2, and 6 and every 8 weeks thereafter	At least 1 year	2 patients with “complete responses”	Unclear
Wozel 2008 [37], case report	1	Infliximab 5 mg/kg IV at week 0, 2, and 6 and every 8 weeks thereafter	8 months	“Marked improvement” 4 days after staring infliximab, with “severe” relapse at 8 months	No SAEs reported
Ahmad 2006 [39], case series	1 (series of 12 psoriasis patients)	Infliximab 5 mg/kg IV at week 0, 2, 6 and every 8 weeks thereafter	Not described	Excellent improvement after third infusion	No SAEs reported; discontinued due to elevated liver function tests
Ustekinumab
Morales-Munera 2013 [45], case series	5	Ustekinumab 45 mg SC at weeks 0, 4, and every 12 weeks thereafter	Mean 15.2 months, range 11–23 months	All patients with positive response 2-3 weeks after first dose, all with complete resolution at week 20 maintained to date with no flares	No AEs reported
Buder 2016 [51], case series	9	Ustekinumab (45 mg if < 100 kg body weight, 90 mg if > 100 kg body weight at weeks 0, 4, 12, 24)	24 weeks	After 24 weeks, 44.4% reached PPASI-75, 22.2% reached PPASI-100, PPASI improvement was 71.6%; goal: improve PPASI by 75% after 12 weeks or improve DLQI by 5 points	No AEs reported; recurrence in 1 patient required stopping treatment and switching to golimumab with improvement

BIW Twice weekly, d/c discontinued DM diabetes mellitus, TB tuberculosis, PPD purified protein derivative, HCV hepatitis C