Pustular psoriasis and the potential therapeutic usage of an IL-36 receptor monoclonal antibody

Pustular psoriasis is an uncommon subtype of psoriasis that dramatically affects the quality of life of affected patients. Pustules can emerge anywhere along the trunk, limbs, soles, palms, and fingers, which debilitates the functionality of these appendages. Currently, there are no approved treatments for pustular psoriasis in the US; off-label usage of psoriasis vulgaris medications is usually prescribed. These treatments are insufficient for patients with difficult to manage or severe forms of pustular psoriasis. Psoriasis vulgaris biologic medications mainly target the IL-17 and IL-23 axis. However, novel clinical findings have demonstrated that pustular psoriasis’s central inflammatory axis depends on the dysregulation of the IL-36 family of cytokines. The lack of inhibition of IL-36α, IL-36β, IL-36γ, as well as the absence of insufficiency of an IL-36 receptor antagonist (IL-36RA), is involved in the upregulation of proinflammatory cytokines and neutrophil chemotaxis necessary for pustular lesion formation. An IL-36 receptor monoclonal antibody can potentially disrupt the IL-36 inflammatory loop and inhibit the pathogenesis of pustular psoriasis. Spesolimab is an IL-36 receptor (IL-36R) monoclonal antibody undergoing clinical trials for the treatment of pustular psoriasis that has exhibited promising results