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Spesolimab

December 2022

Author: Dr Audrey Ho, Resident, Singapore General Hospital, Singapore (2022).
Reviewing dermatologist: Dr Ian Coulson

Edited by the DermNet content department


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Introduction

In September 2022, spesolimab was approved by the US Food and Drug Administration (FDA) as a biological treatment for generalised pustular psoriasis flares (Spevigo®).

In October 2021, the European Medicines Agency (EMA) validated the marketing authorisation application, which is under review.

What is spesolimab used for?

Spesolimab is approved for use in generalised pustular psoriasis (GPP).

There are also trials evaluating the efficacy of spesolimab for palmoplantar pustulosis. A pilot study (Mrowietz et al, 2021) found that spesolimab was well tolerated but did not meet the primary endpoint for efficacy in treating palmoplantar pustulosis. A phase IIb trial is underway.

More images of generalised pustular psoriasis

How does spesolimab work?

Spesolimab is a humanised monoclonal antibody that binds to interleukin 36 (IL-36) receptors and prevents binding of IL-36, preventing activation of proinflammatory pathways. 

As the IL-36 pathway is integral in the pathogenesis of GPP, its downregulation is proposed to help relieve GPP flares.

IL-36 has also been shown to play a role in the pathogenesis of palmoplantar pustulosis, and the use of spesolimab in this context is being investigated.

Spesolimab dosing and administration

  • Administered as a single 900mg dose (diluted prior to administration in sterile 0.9% sodium chloride injection) by intravenous (IV) infusion over 90 minutes.
  • Not to be combined with other medications during infusion.
  • The infusion should be discontinued if a reaction occurs. In the case of mild reaction, restarting the infusion at a slower rate (over maximum 180 mins) can be considered.
  • If GPP symptoms persist, an additional 900mg dose one week after the initial dose can be given.

What are the benefits of spesolimab?

Effisayil-1, a phase II, multi-centre, randomised, double-blind, placebo-controlled trial (Bachelez et al, 2021), examined the efficacy of spesolimab in 53 patients with moderate-to-severe generalised pustular psoriasis (GPP) flares.

  • Spesolimab was associated with a higher incidence of lesion clearance at 1 week compared to placebo, as assessed using the GPP Physician Global Assessment (GPPGA) score.
  • To be eligible for randomisation, patients had to have a GPPGA score of ≥3.
  • One week after administration of either 900mg IV spesolimab or placebo, 54% of patients in the spesolimab group had a pustulation subscore of 0, compared to 6% in the placebo group (p <0.001).

What are the potential side effects of spesolimab?

Reported side effects in patients given spesolimab include:

Warnings

  • May increase risk of infection.
  • Evaluate patients for tuberculosis before treatment with spesolimab.
  • Manufacturer advises avoiding concurrent use of live vaccinations with spesolimab. See also: Immunisation in immunosuppressed dermatology patients.
  • There is limited or no data on the use and safety of spesolimab in pregnant, breastfeeding, paediatric, or geriatric patients.

What are the contraindications to spesolimab?

  • Severe or life-threatening hypersensitivity to spesolimab or its excipients.
  • Do not give spesolimab during clinically significant active infection, including active tuberculosis infection.

New Zealand approved datasheets are the official source of information for prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.

If you are not based in New Zealand, we suggest you refer to your national drug approval agency for further information about medicines (eg, the Australian Therapeutic Goods Administration and the US Food and Drug Administration) or a national or state-approved formulary (eg, the New Zealand Formulary and New Zealand Formulary for Children and the British National Formulary and British National Formulary for Children).

 

Bibliography

  • Bachelez H, Choon SE, Marrakchi S, et al. Inhibition of the Interleukin-36 Pathway for the Treatment of Generalized Pustular Psoriasis. N Engl J Med. 2019;380(10):981–3. doi 10.1056/NEJMc1811317. Journal
  • Bachelez H, Choon SE, Marrakchi S, et al. Trial of Spesolimab for Generalized Pustular Psoriasis. N Engl J Med. 2021;385(26):2431–40. doi 10.1056/NEJMoa2111563. Journal
  • Boehringer Ingelheim Pharmaceuticals. Spevigo Prescribing Information. Sept 2022. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/761244s000lbl.pdf
  • Mrowietz U, Burden AD, Pinter A, et al. Spesolimab, an Anti-Interleukin-36 Receptor Antibody, in Patients with Palmoplantar Pustulosis: Results of a Phase IIa, Multicenter, Double-Blind, Randomized, Placebo-Controlled Pilot Study. Dermatol Ther (Heidelb). 2021;11(2):571–85. doi 10.1007/s13555-021-00504-0. Article

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