FcRn blockade clears the autoantibodies in pemphigus and changes nothing

The edition in brief

Today's dermatology desk leads with a negative phase 3 trial in pemphigus. ADDRESS randomised 222 adults with moderate-to-severe pemphigus 2:1 to weekly subcutaneous efgartigimod PH20 or placebo, both on prednisone 0.5 mg/kg. Complete remission on minimal prednisone by week 30 occurred in 35.5 per cent on efgartigimod and 30.3 per cent on placebo (OR 1.19, 95% CI 0.60 to 2.41, P=0.60), and total prednisone consumption was the same. Total IgG and anti-desmoglein-1 and -3 antibodies fell rapidly and Pemphigus Disease Area Index scores did not follow — a clean dissociation between the biomarker and the disease. English population data on generalised pustular psoriasis, covering 991 patients among 25.8 million people, show prevalence up from 20.9 to 32.5 per million between 2008 and 2022, all-cause mortality more than three times that of matched comparators (adjusted HR 3.19, 2.58 to 3.91) and a near-tenfold excess of death from sepsis (9.76, 4.92 to 19.35); onset was earlier in Asian than in White patients, and younger age at diagnosis cost the most life expectancy. A phase 2 trial of deuruxolitinib in 57 adults with severe alopecia areata found 8 mg twice daily clearly better than 16 mg once daily on relative SALT change at week 24 (46.4 vs 18.0), which is a schedule finding rather than a dose finding. A clinical review sets out how Janus kinase inhibitors are actually being used in children with alopecia areata, where only ritlecitinib is licensed and from age 12.