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Lookup NU author(s): Professor Nick ReynoldsORCiD
This is the final published version of an article that has been published in its final definitive form by John Wiley and Sons Inc., 2022.
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© 2021 British Association of Dermatologists. Background: Palmoplantar pustulosis (PPP) is a rare, debilitating, chronic inflammatory skin disease that affects the hands and feet. Clinical, immunological and genetic findings suggest a pathogenic role for interleukin (IL)-1. Objectives: To determine whether anakinra (an IL-1 receptor antagonist) delivers therapeutic benefit in PPP. Methods: This was a randomized (1 : 1), double-blind, two-staged, adaptive, UK multicentre, placebo-controlled trial [ISCRTN13127147 (registered 1 August 2016); EudraCT number: 2015-003600-23 (registered 1 April 2016)]. Participants had a diagnosis of PPP (> 6 months) requiring systemic therapy. Treatment was 8 weeks of anakinra or placebo via daily, self-administered subcutaneous injections. Primary outcome was the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at 8 weeks. Results: A total of 374 patients were screened; 64 were enrolled (31 in the anakinra arm and 33 in the placebo arm) with a mean (SD) baseline PPPASI of 17·8 (10·5) and a PPP investigator’s global assessment of severe (50%) or moderate (50%). The baseline adjusted mean difference in PPPASI favoured anakinra but did not demonstrate superiority in the intention-to-treat analysis [–1·65, 95% confidence interval (CI) –4·77 to 1·47; P = 0·30]. Similarly, secondary objective measures, including fresh pustule count (2·94, 95% CI –26·44 to 32·33; favouring anakinra), total pustule count (–30·08, 95% CI –83·20 to 23·05; favouring placebo) and patient-reported outcomes, did not show superiority of anakinra. When modelling the impact of adherence, the PPPASI complier average causal effect for an individual who received ≥ 90% of the total treatment (48% in the anakinra group) was –3·80 (95% CI –10·76 to 3·16; P = 0·285). No serious adverse events occurred. Conclusions: No evidence for the superiority of anakinra was found. IL-1 blockade is not a useful intervention for the treatment of PPP.
Author(s): Cro S, Cornelius VR, Pink AE, Wilson R, Pushpa-Rajah A, Patel P, Abdul-Wahab A, August S, Azad J, Becher G, Chapman A, Dunnil G, Ferguson AD, Fogo A, Ghaffar SA, Ingram JR, Kavakleiva S, Ladoyanni E, Leman JA, Macbeth AE, Makrygeoegou A, Parslew R, Ryan AJ, Sharma A, Shipman AR, Sinclair C, Wachsmuth R, Woolf RT, Wright A, McAteer H, Barker JNWN, Burden AD, Griffiths CEM, Reynolds NJ, Warren RB, Lachmann HJ, Capon F, Smith CH
Publication type: Article
Publication status: Published
Journal: British Journal of Dermatology
Year: 2022
Volume: 186
Issue: 2
Pages: 245-256
Print publication date: 01/02/2022
Online publication date: 19/08/2021
Acceptance date: 14/07/2021
Date deposited: 24/02/2022
ISSN (print): 0007-0963
ISSN (electronic): 1365-2133
Publisher: John Wiley and Sons Inc.
URL: https://doi.org/10.1111/bjd.20653
DOI: 10.1111/bjd.20653
PubMed id: 34411292
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