32827 Simultaneous nail and skin clearance in 5 ixekizumab head-to-head trials for moderate-to-severe psoriasis and psoriatic arthritis

Abstract

Background: Lifetime incidence of nail psoriasis in patients with moderate-to-severe psoriasis (PsO) is 80-90%, and up to 55% of patients have nail psoriasis at any given time. Nail psoriasis is even more prevalent in patients with psoriatic arthritis (PsA). Complete psoriasis clearance is an achievable therapeutic goal, and ideally should include resolution of psoriasis within nails. Here, we assessed simultaneous skin and nail clearance in patients with psoriasis across 5 head-to-head trials comparing ixekizumab with other biologics. Methods: Data were assessed in patients with PsO (with or without PsA) with nail psoriasis at baseline from the IXORA-R, IXORA-S, UNCOVER-2, UNCOVER-3, and SPIRIT-H2H trials. IXE patients received IXEQ2W to week 12, and IXEQ4W beyond week 12. Complete skin improvement was assessed by PASI 100, and complete nail resolution was assessed by either PGA-F (0) (IXORA-R) or NAPSI (0) (all other trials). Treatment comparisons were evaluated using the Cochran Mantel Haenszel test. Nonresponder imputation was used for missing data. Results: Ixekizumab achieved numerically greater simultaneous skin and nail clearance than etanercept (UNCOVER-2: ixekizumab = 6.8%, etanercept = 0.4%, P < .001, UNCOVER-3: ixekizumab = 10.5%, etanercept = 0.8%, P < .001) at 12 weeks; guselkumab (ixekizumab = 37.9%, guselkumab = 28.0%, P = .079), ustekinumab (ixekizumab = 28.6%, ustekinumab = 8.6%, P < .001), and adalimumab (ixekizumab = 45.9%, adalimumab = 17.1%, P = .006) at 24 weeks; and ustekinumab (ixekizumab = 40.5%, ustekinumab = 16.2%, P < .001), and adalimumab (ixekizumab = 51.4%, adalimumab = 22.0%, P = .007) at 52 weeks. Conclusions: Across five head-to-head trials, ixekizumab-treated patients had higher rates of simultaneous complete skin and nail clearance compared with etanercept, guselkumab, ustekinumab and adalimumab, thereby reinforcing ixekizumab’s ability to achieve high levels of efficacy.