Supplemental Material for: Adalimumab in Generalized Granuloma Annulare: A Systematic Review

Abstract

Introduction: Generalized granuloma annulare (GGA) is an uncommon inflammatory dermatosis characterized by smooth annular plaques and papules, frequently demonstrating resistance to conventional therapies. Anti-tumour necrosis factor-alpha (TNF-α) inhibitors, including adalimumab, have been used to treat refractory cases. However, current evidence remains weak, as it is based on small, heterogeneous studies with non-standardized outcome measures. The objective of this article is to systematically review the published literature regarding the efficacy and safety of adalimumab in the treatment of GGA. Methods: A systematic literature search was conducted across PubMed/MEDLINE, Google Scholar, LILACS, Scopus, and Web of Science. Eligible studies included case reports, case series, observational studies, and clinical studies reporting the use of adalimumab in patients diagnosed with GGA. Experimental studies, animal studies, in vitro studies, and editorials were excluded. Data was extracted on patient characteristics, dosing regimens, treatment response, time to response, relapse following discontinuation, and adverse events. Results: Nineteen studies evaluating the use of adalimumab in GGA were included. The majority of patients demonstrated a clinical response, with most achieving complete or partial improvement, while a minority showed no response. Relapses following treatment discontinuation were reported in some cases, underscoring the chronic nature of the disease and the potential need for ongoing therapy. Adalimumab was generally well tolerated, with adverse events reported in a limited subset of patients. Conclusion: The available evidence suggests that adalimumab is a generally safe and well-tolerated therapeutic option for GGA. Larger prospective studies are needed to better determine its efficacy and safety.