Aims:
Pyoderma gangrenosum (PG) is a rare, autoinflammatory disease that causes painful ulcers. Despite the debilitating nature of this condition, understanding of its pathogenesis and treatment options remains limited.
Current management options range from topical or intralesional steroids, systemic treatment with steroids or immunosuppression. There is emerging evidence for the use of biologics for PG.
This study aims to summarise the outcomes of patients with PG who have received biologics at Monash Health.
Methods:
A single-centre, retrospective cohort study was conducted on PG patients at Monash Health, a tertiary referral hospital in Melbourne, Victoria. Patients who received biologics for PG between 26th August 2011 and 4th April 2024 were identified through an in-house database. A chart review was carried out to extract data including drug survival, change in symptoms, prednisolone dosage, concurrent therapies and comorbidities.
Results:
25 patients were identified as having received biologics for PG, totalling 42 instances. Among these, 19.05% (n=8) received infliximab, 45.24% (n=19) received ustekinumab, 23.81% (n=10) received adalimumab, 4.76% (n=2) received canakinumab, 4.76% (n=2) received secukinumab, and 2.38% (n=1) was prescribed anakinra. 78.9% (n=15/19) of patients who received ustekinumab developed partial or complete clinical response. Amongst patients treated with infliximab and adalimumab, 62.5% (5/8) and 40% (4/10) of patients experienced at least partial improvement respectively.
Drug survival was also calculated for each biologic. The overall mean drug survival was 20.74 months. Ustekinumab had the longest drug survival, with a mean of 23.20 months. By the time of outcome measure, 46.29% (n=27) patients were no longer on biologics- 14.29% (n=6) ceased biologics due to complete resolution, and 23.81% (n=10) due to worsening disease.
Conclusion:
We present a case series of 42 instances of biologic therapy used for pyoderma gangrenosum. The most commonly used biologic was ustekinumab, which was an effective treatment with the longest drug survival.