Table 3.
Palmoplantar pustulosis, efficacy and safety of biologic agents
| Reference, type of study | Number of subjects | Treatment | Treatment duration | Outcome | Safety/comments |
|---|---|---|---|---|---|
| Adalimumab | |||||
| Olazagasti 2017 [22], retrospective cohort study | 8 | Adalimumab, etanercept, infliximab | 1996–2013 | Partial response to adalimumab (2; no response to adalimumab (2); no response to etanercept (3); partial response to infliximab (1) | No AEs reported |
| He 2012 [23], case report | 1 | Adalimumab 40 mg SC q 2 weeks + methotrexate 15 mg weekly | 1 month | Response of PP not described | No SAEs reported; acneiform eruption, alopecia areata, and urticaria after third injection leading to d/c |
| Etanercept | |||||
| Bissonnette 2008 [12], Double-blind randomized placebo-controlled trial | 15 | 2:1 etanercept 50 mg SC BIW week 0-24 vs. placebo weeks 0–12 then etanercept 50 mg SC BIW weeks 12–24 | 6 vs. 3 months | Significant decrease in median PPPASI at week 24 in etanercept group; no significant difference between groups at 12 weeks (primary end point) (p = 0.426) | No SAEs reported; Decreased PPPASI in 3/3 nonsmokers (increased PPPASI in 4/7 smokers) in etanercept group at 12 weeks |
| Lopez-Estebaranz 2010 [29], case report | 1 | Etanercept 50 mg SC BIW for 12 weeks, then weekly for 12 weeks | 6 months | At week 12, complete resolution; maintained clearance for 6 months after discontinuation of etanercept | No AEs reported |
| Kasche 2007 [31], case report | 1 | Etanercept 25 mg SC BIW | 7 months | “Sudden and dramatic improvement” at 2 weeks; restarted due to flare after d/c with “dramatic and rapid improvement” after 1 week | No SAEs reported |
| Weinberg 2003 [32], Case report | 1 | Etanercept 25 mg SC BIW | 19 weeks | At 19 weeks, “almost total clearing” of hands with “mild to moderate scaling” of feet, resolution of PsA symptoms | No AEs reported |
| Abourazzak 2014 [49], case report | 1 | Etanercept 25 mg twice weekly | 12 months | Resolved; “good improvement within the first month” | No AEs reported |
| Infliximab | |||||
| Burgemeister 2012 [20], case series | 2 (subset of 3 PPP) | Infliximab (5 mg/kg q 8 weeks) | Not reported | complete resolution | No AEs reported |
| Aljuhani 2015 [50], case series | 2 (subset of 20 PPP) | (1) Infliximab; (2) adalimumab, etanercept | (1) 3 years; (2) 9 months |
(1) completely resolved; (2) no response to adalimumab, then switched to etanercept with no response |
No AEs reported |
| Yawalkar 2009 [36], Case report | 1 | Infliximab 5 mg/kg IV at weesk 0, 2, 6; then at week 14 adalimumab 40 mg SC q 2 weeks then 40 mg SC weekly | 6 weeks infliximab, then ≥ 3 months adalimumab | “Marked improvement” at 2 weeks with recurrence at week 14; slower but satisfactory clinical response with adalimumab | 1 SAE: infusion related reaction with polyarthalgia, myalgia and fever at week 6 leading to discontinuation |
| Fairhurst 2008 [38], Case report | 1 | Infliximab 5 mg/kg IV at weesk 0, 2, 6 | 6 weeks | “Dramatic improvement” after first 2 infusions, “deterioration” after third infusion | 1 SAE: autoimmune hepatitis |
| Barland 2003 [40], Case report | 1 | Infliximab 5 mg/kg IV monthly months 0–4, infliximab 10 mg/kg IV monthly months 5-6, then infliximab 10 mg/kg IV monthly + methotrexate 7.5 mg PO weekly | Not reported | Initial “dramatic response” followed by relapse; addition of methotrexate led to “virtually absent” lesions within 2 weeks with “lasting remission” | No AEs reported |
| Ustekinumab | |||||
| Torre 2017 [53], case report | 1 | Adalimumab (40 mg SC every other week × 4 months then 40 mg weekly × 6 months) + mycophenolate + Ustekinumab (90 mg on day after 10 months at days 1, 28, then q 3 months) | 14 months | 95% clearance after 14 months | No AEs reported |
| Pinto-Almeida 2013 [46], Case report | 1 | Ustekinumab 45 mg SC at weeks 0, 4, and every 12 weeks thereafter | 12 months | Clinical improvement noted at 3 weeks and clearance achieved at 16 weeks; sustained response at 12 months | No AEs reported |
| de Unamuno-Bustos 2011 [47], Case report | 1 | Ustekinumab 45 mg SC q 12 weeks | 8 months | After 2 doses “almost complete clearance”; remained clear of lesions at 8 months | No AEs reported |
| Gerdes 2010 [48], case series | 4 | Ustekinumab 45 mg or 90 mg (if ≥ 100 kg) SC q 12 weeks | 2 months to unclear | Failure in 2 subjects (1 and 2); slow improvement in 1 subject (palms clear but soles still affected at 3 months); decreased pustules and involved area of both soles at 3 months in 1 subject | No AEs reported |