Abstract: 【Abstract】 Objective To evaluate the efficacy and safety of spesolimab in the treatment of generalized pustular psoriasis （GPP）. Methods Six patients with GPP were collected from the Affiliated Hospital of Nanjing University Medicine School from February 2024 to March 2024, including 2 males and 4 females, aged 16 - 50 years. Four patients had a history of plaque psoriasis. Before treatment, the GPP Area and Severity Index （GPPASI） scores of the patients ranged from 24.6 to 60.8 points, and their GPP Physician Global Assessment （GPPGA） scores ranged from 2 to 4 points. All the 6 patients were intravenously injected with 900 mg of spesolimab. Their GPPASI and GPPGA scores were recorded at weeks 1, 4, and 12, and adverse reactions were monitored during the treatment and follow-up. Results Twenty-four hours after treatment, pustules were markedly reduced in the 6 patients with GPP; at week 1, pustules completely subsided, but erythema persisted; at week 4, both GPPASI and GPPGA scores decreased to 0 points; at week 12, no recurrence was observed. The patients with comorbid hypertension （4 cases）, diabetes （1 case）, or kidney disease （2 cases） maintained stable blood glucose and pressure levels, or showed improved renal function during the treatment and follow-up. Two patients experienced a transient fever after the treatment with spesolimab, resolving spontaneously after two days; two others exhibited exacerbation of plaque psoriasis. During the 12-week follow-up, none of the 6 patients experienced serious adverse reactions such as infections. Conclusions Spesolimab demonstrated rapid-onset efficacy and favorable safety in the treatment of GPP. Conventional-dose spesolimab remained safe for GPP patients with kidney disease.

Key words: Psoriasis, Treatment outcome, Generalized pustular psoriasis, Spesolimab