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Effective systemic treatments for pyoderma gangrenosum
Clinical Question
What systemic treatments are associated with complete or partial healing of pyoderma gangrenosum lesions?
Bottom line
One well-designed randomized controlled trial found that prednisolone and cyclosporine produced similar rates of complete or partial healing of pyoderma gangrenosum lesions at 6 months (47%). Observational studies found similar results for other corticosteroids and high rates of healing with infliximab and canakinumab. The available observational data come from mostly small and lower-quality studies with too much heterogeneity to conduct a meta-analysis. 3a
Reference
Study design: Systematic review
Funding: Self-funded or unfunded
Setting: Various (meta-analysis)
Synopsis
The authors conducted a thorough and well-designed literature search to identify observational studies and clinical trials of systemic treatments for pyoderma gangrenosum (N = 41, with 704 adult participants). Only one reasonably large randomized controlled trial was identified with 121 participants. It compared prednisolone 0.75 mg/kg daily with cyclosporine 4 mg/kg daily. After 6 weeks of treatment complete healing occurred in 15% and 21% of participants, respectively. At 6 months both treatments provided a rate of complete healing of 47%. The authors were unable to conduct a meta-analysis of the 37 observational studies because of the studies' heterogeneity. Three other clinical trials were small and/or open-label. The authors judged that there was sufficient observational data to support the use of corticosteroids, cyclosporin, and biologics. The most commonly used biologics were infliximab and canakinumab. Across studies, complete healing was observed in 60% to 80% of participants, generally over 2 months to 4 months with great variability. Frequent use of concurrent therapies and/or patient co-morbidities made it difficult to make comparisons and draw conclusions.
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH
Comments
Good poem
Pyoderma gangrenosa is ulcerative skin disease, commonly associated with rhemotoid artheritis and inflammatory bowel disease. It is important to know it has effective systemic treatment.