• 16 May 2024
• Admin
• News Article

CDSCO Approves Boehringer Ingelheim’s Spevigo to Treat Psoriasis

CDSCO approves Boehringer Ingelheim’s Spevigo to treat generalized pustular psoriasis flares in adults

Overview

The Central Drugs Standard Control Organisation (CSDCO) in India has approved Boehringer Ingelheim’s Spevigo (spesolimab) injection, a first-in-class treatment for generalized pustular psoriasis (GPP) flares in adults. Spesolimab is a novel, selective antibody that blocks the activation of the interleukin-36 receptor (IL-36R), a signalling pathway within the immune system shown to be involved in the pathogenesis of GPP. 

EFFISAYIL 1 Phase II Trial

• In the EFFISAYIL 1 phase II global clinical trial, patients experiencing a GPP flare were treated with spesolimab or placebo. 
• Most patients at the outset of the trial had a high, or very high, density of pustules, and impaired quality of life. 
• After one week, 54% of patients treated with spesolimab showed no visible pustules compared to placebo (6%). 

In India, GPP presents a significant healthcare challenge, affecting individuals of all ages and demographics. While precise prevalence data for GPP in India is limited, GPP is widely recognized as a rare disease. 

GPP

• GPP is a rare and unpredictable systemic disease, with predominant skin symptoms, that is distinct from plaque psoriasis in both its disease mechanism and severity. 
• Given that it is so rare, recognizing the symptoms can be challenging, which leads to delays in diagnosis. 
• It manifests with painful pus-filled blisters, redness, inflammation, and scaling on the skin, often accompanied by systemic symptoms like fever and fatigue. 
• Timely diagnosis and treatment are crucial, yet challenges in misdiagnosis and delayed intervention persist, due to the rarity of GPP and its similarities to other skin conditions like psoriasis, leading to inadequate management and prolonged suffering for patients. 
• Moreover, triggers for GPP flares, including stress, infections, certain medications, hormonal changes, and environmental factors, vary widely among individuals, making it challenging to predict and manage the condition effectively. 

From Boehringer Ingelheim India

• “The approval of Spevigo by the CDSCO represents a significant milestone in GPP management in India and underscores our commitment to bringing novel therapies into the country. We often take our skin for granted. However, for a small percentage of people with a rare, lifelong skin disorder, living in constant anticipation of possible flares that could require emergency medical care is a harsh reality. Some patients often describe the feeling as akin to ‘being on fire’. Spevigo's impact goes beyond treatment; it's about giving patients the chance to reclaim their lives. It presents a promising opportunity for enhancing effective management, quality of life, and patient outcomes in India, instilling hope for individuals grappling with GPP,” said Gagandeep Singh Bedi, managing director, Boehringer Ingelheim India.
• Dr Shraddha Bhure, medical director, Boehringer Ingelheim India highlighted the significance of this development. “GPP is a debilitating condition, with serious symptoms like flares and pustules that can significantly impact patients' ability to perform daily activities, often leading to significant morbidity and impaired quality of life. Spevigo, a targeted therapy, has been shown to effectively reduce the severity of GPP flares, providing patients with an innovative treatment that specifically targets the underlying inflammation associated with GPP, thus providing relief from the distressing symptoms of the disease.”  

About GPP and Early Diagnosis

• People living with GPP often do not receive a correct or timely diagnosis and may have their symptoms identified as other forms of psoriasis. 
• A Global Consensus Delphi Panel of experts concluded a systematic literature review that classified GPP as phenotypically, genetically, immunologically, and histopathologically distinct from psoriasis vulgaris/plaque psoriasis. 
• The growing list of regulatory approvals for Spevigo underlines that the Delphi panel’s vision of improved diagnosis and treatment for people with GPP is increasingly achievable. 

Trial Outcomes

• The Effisayil global clinical trial program evaluated the largest and broadest population of GPP patients in trials of a therapy specifically targeting the IL-36 pathway for GPP: Effisayil 1: A phase II study that demonstrated treatment with a single intravenous dose of spesolimab significantly improved signs and symptoms of generalized pustular psoriasis (GPP) in patients experiencing a flare. 
• These results supported the approval of spesolimab (Spevigo) as the first specific treatment for GPP flares in adults in major markets; Effisayil 2: The trial assesses the role of spesolimab in prevention of flares of GPP; Effisayil ON: An open-label extension study to evaluate the long-term safety and efficacy of spesolimab in patients with GPP, who have completed previous spesolimab trials. 

All About GPP

• GPP is a rare, heterogenous, and potentially life-threatening neutrophilic skin disease, which is globally clinically distinct from plaque psoriasis. 
• GPP is caused by neutrophils (a type of white blood cell) accumulating in the skin, resulting in painful, sterile pustules all over the body. 
• The global clinical course varies, with some patients having a relapsing disease with recurrent flares, and others having a persistent disease with intermittent flares.
• While the severity of GPP flares can vary, if left untreated they can be life-threatening due to complications such as sepsis and multisystem organ failure. 
• This chronic, systemic disease has a substantial quality of life impact on patients and increased healthcare burden. 
• GPP has a varied prevalence across different geographical regions and more women are affected than men. 
• There is a high unmet need for treatments that can rapidly resolve the symptoms of GPP flares and prevent their reoccurrence, with an acceptable safety profile. 

GPP flares can lead to hospitalization with serious complications, including heart failure, renal failure, and sepsis, and the unpredictability and severity of these flares greatly affect a person’s quality of life.