P135 Advanced therapies in pyoderma gangrenosum: insights from a UK dermatology centre

Abstract

Pyoderma gangrenosum (PG) is a rare, ulcerative dermatosis associated with significant pain and psychosocial distress. No advanced therapies are licensed for PG. We present a retrospective evaluation of advanced therapies in patients with PG at a UK dermatology centre. In the absence of validated severity assessment tools, clinical photographs were used to assess Pyoderma Gangrenosum Area Reduction 100 (PGAR 100; complete re-epithelialization) and PGAR 50 (≥ 50% ulcer-area reduction). Where photographs were unavailable, responses were assessed from clinical notes as effective, partial response (PR), primary failure (PF), secondary failure (SF) or early discontinuation (ED). Ten patients were identified (mean age 43.9 years, male-to-female ratio 1:1); 40% had inflammatory bowel disease. The mean duration of PG was 11 years, with a mean 4.7 prior systemic immunosuppressants. Five patients received one advanced therapy and five received two, yielding 15 episodes: adalimumab (n = 6), ustekinumab (n = 4), infliximab (n = 3) and tofacitinib (n = 2). The mean treatment duration was 23.1 months. PGAR 100 and PGAR 50 were assessable via photographs in 10 of 15 episodes; no treatment achieved PGAR 100. PGAR 50 was observed as follows: adalimumab 0 of 2, ustekinumab 2 of 3, infliximab 2 of 3 and tofacitinib 1 of 2. Review of clinical notes showed variable responses: adalimumab – 2 PR, 2 PF, 1 SF, 1 ED; ustekinumab – 2 effective, 1 PF, 1 SF; infliximab – 1 effective, 1 PR, 1 PF; tofacitinib – 1 effective, 1 PF. Overall, 80% of patients had no PG-related hospital admissions. Adverse events occurred in 40% of treatment episodes, leading to discontinuation in four cases: arthralgia (adalimumab), serious infection (tofacitinib) and rash or infusion reaction (infliximab). Limitations of this study include the small sample size, lack of validated severity measures and incomplete photographic documentation. This study provides real-world insight into advanced therapies for PG, suggesting variable effectiveness, with ustekinumab and infliximab showing the most favourable responses. Earlier biologic use may improve outcomes and reduce healthcare utilization. Prospective studies and validated severity tools are needed.