Short-course vunakizumab associated with rapid improvement of acute flares in paediatric generalised pustular psoriasis: a three-patient case series.

Background: Paediatric generalised pustular psoriasis (GPP) is rare, frequently relapsing and associated with limited evidence for targeted therapy. Vunakizumab is an anti-interleukin-17A monoclonal antibody, but data in paediatric GPP are scarce. Methods: We retrospectively reviewed three boys with recurrent GPP who received short-course vunakizumab during acute flares. Clinical characteristics, diagnostic details, treatment timelines, follow-up outcomes and Generalized Pustular Psoriasis Area and Severity Index (GPPASI) scores were collected. Results: A 13-year-old boy (87.5 kg) with ciclosporin-dependent recurrent GPP received vunakizumab 240 mg at weeks 0 and 2 with concomitant topical therapy; GPPASI decreased from 18 to 1, and no relapse was documented during approximately 6 months of follow-up. An 8-year-old boy (35 kg) received a single 120-mg administration; GPPASI decreased from 11 to 2, and no recurrent pustular eruption was reported during approximately 15 months of available follow-up, which was predominantly remote after the initial visit. Another 8-year-old boy (32 kg) with a febrile flare received two 120-mg administrations; GPPASI decreased from 14 to 2, and no relapse was documented during approximately 3 months of follow-up. No adverse events considered treatment-related were documented during the available observation periods. Conclusion: Short-course vunakizumab was temporally associated with rapid clinical improvement in three paediatric patients with acute GPP flares. Larger prospective studies with standardised follow-up are needed to evaluate efficacy, paediatric dosing, relapse prevention and long-term safety.