FcRn blockade adds nothing to steroids in pemphigus at 30 weeks

The edition in brief

In ADDRESS, a phase 3 double-blind trial in 222 adults with moderate-to-severe pemphigus, weekly subcutaneous efgartigimod plus prednisone did not raise the rate of complete remission on minimal prednisone by week 30 in pemphigus vulgaris compared with placebo plus prednisone (35.5% vs 30.3%; OR 1.19, 0.60-2.41). Autoantibody levels fell fast, but disease activity and steroid use did not differ. A population study in England (25.8 million people, 2008-2022) identified 991 people with generalised pustular psoriasis; prevalence rose by more than half, was higher in Asian people, and onset came earlier in Asian than in White patients. All-cause mortality was about three times that of matched comparators (aHR 3.19), and death from sepsis nearly ten times (aHR 9.76). A meta-analysis of four small studies (171 participants) found indoor or simulated daylight PDT for actinic keratosis was less likely to clear lesions completely at three months than conventional lamp PDT (RR 0.86) but cut illumination pain by about 4.4 points and was preferred by patients. The pearl is a reminder of why systemic steroids are avoided in plaque psoriasis.