A single IL-36 receptor antibody infusion cleared pustules within a week in pustular psoriasis flares

Design

Phase 2, multicentre, randomised, double-blind, placebo-controlled trial

Population

33 patients in China with moderate-to-severe acute generalised pustular psoriasis

Primary outcome

GPPGA pustulation sub-score 0 or 1 at day 8

Effect

86.4% vs 9.1%; difference 77.3% (95% CI 42.5 to 88.9)

A multicentre, double-blind, placebo-controlled phase 2 trial in China (British Journal of Dermatology, 3 September 2026) randomised 33 patients with moderate-to-severe acute generalised pustular psoriasis 2:1 to a single 1,050 mg intravenous dose of recibokibart, an antibody against the IL-36 receptor, or placebo.

By day 8, 86.4% on recibokibart had a pustulation sub-score of 0 or 1, against 9.1% on placebo. Complete pustule clearance at day 8 was 54.5% against none. Improvement appeared within 24 hours, and by week 4, 72.7% had reached a 75% fall in disease area and severity. Low protein, raised triglycerides and itch were the commonest adverse events.

The effect is large, but this is a small phase 2 trial, and results after day 8 include open-label treatment. Spesolimab, which targets the same receptor, has shown the IL-36 pathway can be switched off quickly in these flares. Recibokibart's regulatory status in India is unknown.

• Treat an acute pustular psoriasis flare as a medical emergency; check temperature, fluids, albumin and calcium.
• Where an IL-36 receptor antibody is available, consider it for severe flares; responses here came within days.
• Monitor protein and lipids if using an IL-36 receptor antibody.
• Avoid stopping systemic corticosteroids abruptly in psoriasis, a recognised trigger for pustular flares.

Why it matters

A second agent acting on the same pathway strengthens the case that IL-36 blockade is the targeted treatment for these flares.

Don't overread it

Thirty-three patients in a phase 2 trial; this is not yet evidence for approval or routine use.

The statistics, in plain English

A difference of 77 percentage points is very large, but with only 22 and 11 patients the 95% confidence interval runs from 43 to 89 points. Results after day 8 are harder to interpret because placebo patients could switch to active drug.

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