Improvement In Nail Psoriasis Research Articles

Assessing Comparative Efficacy of Biologics for the Treatment of Psoriasis With Nail Involvement: A Systematic Review.

Despite recent advances in biologics, there is a lack of significant evidence regarding the comparative efficacy of biologics in treating more resistant features of psoriasis, namely nail psoriasis. A systematic review synthesizing data from multiple studies is efficacious in assessing the comparative efficacy among biologics for the treatment of nail psoriasis. To evaluate and compare the efficacy of biologics for the treatment of nail psoriasis. Utilizing PRISMA guidelines, a systematic literature review was conducted using the Pubmed database on November 16, 2022. Studies selected were phase 3 or 4 randomized clinical trials, clinical studies, or other randomized trials with data on the treatment with biologics for adults with nail psoriasis. Sixteen studies meeting inclusion criteria were included for analysis. At 24weeks, the highest mean NAPSI percent improvement achieved at week 24 was by brodalumab (76.9%) followed by etanercept (74%) and ixekizumab (70.5%) while the biologics achieving the greatest proportion of NAPSI 0 were adalimumab (44.6%) and ixekizumab (41%). This study helps elucidate the comparative efficacy of biologics for the treatment of nail psoriasis. This review suggests that brodalumab and etanercept are associated with the highest percent improvement in nail psoriasis while adalimumab and ixekizumab are associated with the greatest probability of complete nail resolution.

Fractional CO2 Laser-Assisted Delivery Versus Intralesional Injection of Methotrexate in Psoriatic Nails.

Nail psoriasis has a major negative impact on physical and psychological aspects of the patient's life. Treatment is often unsatisfactory because of difficult penetration of the drug into the nail. To evaluate and compare the efficacy of laser-assisted delivery of methotrexate versus its intralesional injection in fingernail psoriasis. Twenty-eight patients with fingernail psoriasis were divided into 2 groups of 14 patients each. Group A was treated with intralesional injection of methotrexate while Group B received fractional CO2 laser followed by topical application of methotrexate. The treatment was given at a 2-week interval for 6 sessions. The improvement of nail psoriasis was assessed by clinical and dermoscopic evaluation. At the end of treatment, both laser-assisted delivery and intralesional injection of methotrexate were associated with statistically significant improvement of psoriatic signs. No statistically significant difference was found between the 2 groups regarding total nail psoriasis severity Index (p = .18), matrix score (p = .38), bed score (p = .23), and dermoscopic score (p = .78). However, the pain and subungual hematoma were significantly less in the laser group (p < .001 and p = .03, respectively). Fractional CO2 laser-assisted delivery of methotrexate can be an effective and well-tolerated alternative to intralesional injection in nail psoriasis.

Clinical parameters associated with severity of nail psoriasis and therapeutic efficacy.

Nail involvement is common in psoriasis patients, however, there are few detailed studies of clinical parameters related to disease severity and therapeutic efficacy. Our retrospective study aimed to describe the prevalence and clinical characteristics in nail psoriasis patients and determine possible associations between multiple clinical parameters and disease severity or therapeutic efficacy. A total of 89 nail psoriasis patients were included and investigated using dermoscopy. The Nail Psoriasis Severity Index (NAPSI) and the Nijmegen-Nail Psoriasis Activity Index tool (N-NAIL) were used to measure the severity and improvement of nail psoriasis. Severity and efficacy-related parameters were also analysed. Subungual hyperkeratosis (94.4%) was the most commonly observed nail feature. Coexistence of pitting and leukonychia, transverse grooves and thickening were more commonly observed in juveniles than adults. Patients with more severe nail psoriasis were more likely to have more nails affected and develop discolouration. The efficacy of treatment after fixed intervals of treatment was analysed. Most clinical parameters were not related to therapeutic efficacy, including disease duration, age at onset and number of nail signs. However, after six months of treatment, the presence of transverse grooves was shown to be associated with better efficacy. Based on comparison of NAPSI and N-NAIL scores relative to the first visit, the presence of transverse grooves, longitudinal ridges or discolouration were associated with better efficacy. Clinicians should be aware of the clinical parameters related to severity and the use of therapeutic efficacy in choosing individualized treatment and predicting prognosis.

P255 Secukinumab provides sustained improvement in nail psoriasis and inhibition of radiographic progression in PsA patients with nail phenotype: 52-week results from a Phase 3 study

Abstract Background Nail psoriasis (PsO) affects up to 80% of patients with psoriatic arthritis (PsA) and is associated with significant pain, psychosocial disability and decreased physical function and quality of life (QoL). Secukinumab demonstrated efficacy for patients with nail PsO in TRANSFIGURE, and improvements in the signs and symptoms and low radiographic progression in patients with PsA in FUTURE 5 (NCT02404350). We report the efficacy of secukinumab on nail PsO and other disease facets, including radiographic progression, in the nail subset from FUTURE 5 through 52 weeks. Methods Patients (N = 996) with active PsA were randomised to subcutaneous secukinumab 300 mg loading dosage (LD), 150 mg LD, 150 mg no LD or placebo. All groups received secukinumab or placebo at baseline, Weeks 1, 2, 3 and 4, and every 4 weeks thereafter. Efficacy assessments through Week 52 included mNAPSI, radiographic progression (mTSS), ACR, PASI, HAQ-DI, SF-36 physical component summary, PsAQoL, and dactylitis and enthesitis resolution. Analyses through Week 16 used non-responder imputation for binary and mixed-effect model repeated measures for continuous variables. Data beyond Week 16 are presented as observed. Results 663/996 (66.6%) of PsA patients had concomitant nail PsO at baseline. Baseline characteristics were balanced between groups. The total mean mNAPSI score at baseline was 16.4. Secukinumab 300 and 150 mg LD, improved nail PsO vs placebo at Weeks 8, 12 and 16 (all P &amp;lt; 0.0001, except secukinumab 150 mg LD vs placebo at Week 8 [p = 0.0002]), with further improvements through Week 52. Mean change from baseline in mTSS score at Weeks 24 and 52 are shown in the Table. Proportions of patients with no radiographic progression (change from baseline in mTSS≤0.5) with secukinumab at 52 weeks were 94.0% (300 mg LD), 83.5% (150 mg LD) and 88.4% (150 mg no LD). ACR20/50 and PASI 90 responses, dactylitis and enthesitis resolution, physical function and QoL also improved with secukinumab vs placebo at Week 16, with sustained improvements through 52 weeks. Conclusion Secukinumab provided sustained improvements in nail disease, signs and symptoms of PsA, physical function and QoL, along with low radiographic progression, through 52 weeks in PsA patients with moderate-to-severe nail PsO. Disclosures B. Kirkham: Consultancies; Gilead, AbbVie, Janssen, Lilly, Novartis, Roche. Honoraria; Gilead, AbbVie, Janssen, Lilly, Novartis, Roche. Grants/research support; Gilead, AbbVie, Janssen, Lilly, Novartis, Roche. P. Nash: Honoraria; Novartis, AbbVie, Roche, Pfizer, Bristol-Myers Squibb, Janssen, Celgene. Grants/research support; Novartis, AbbVie, Roche, Pfizer, Bristol-Myers Squibb, Janssen, Celgene. P.J. Mease: Consultancies; AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Crescendo Bioscience, Galapagos, Gilead, Genentech, GlaxoSmithKline, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharmaceutical Industries, INC pharma, UCB. Member of speakers’ bureau; AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Crescendo Bioscience, Genentech, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, UCB. Grants/research support; AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Crescendo Bioscience, Genentech, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharmaceutical Industries, INC pharma, UCB. A.C. Balsa: Consultancies; Pfizer, AbbVie, Bristol-Myers Squibb, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion, UCB. Honoraria; Pfizer, AbbVie, Bristol-Myers Squibb, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion, UCB. Grants/research support; Pfizer, AbbVie, Bristol-Myers Squibb, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion, UCB. A. Singhal: Member of speakers’ bureau; AbbVie. Grants/research support; AbbVie, Gilead, Sanofi, Regeneron, Amgen, Roche, Bristol-Myers Squibb, Janssen, Lilly, Novartis, Pfizer, UCB, AstraZeneca, MedImmune, FujiFilm, Nichi-Iko, Mallinckrodt. E. Quebe-Fehling: Shareholder/stock ownership; Novartis. Other; Employee of: Novartis. L. Pricop: Shareholder/stock ownership; Novartis. Other; Employee of: Novartis. C. Gaillez: Shareholder/stock ownership; Novartis, Bristol-Myers Squibb. Other; Employee of: Novartis.

Improvement in nail psoriasis with brodalumab treatment over 52 weeks: An analysis of two phase 3 studies

Improvement in nail psoriasis with brodalumab treatment over 52 weeks: An analysis of two phase 3 studies

Improvement of Nail Psoriasis with Brodalumab in Phase 3 Trials

Abstract Not Available

Adalimumab for nail psoriasis: Efficacy and safety from the first 26 weeks of a phase 3, randomized, placebo-controlled trial

Previous clinical trials have not evaluated improvement in nail psoriasis as a primary end point. This phase 3 trial evaluated the safety and efficacy of adalimumab in patients with moderate-to-severe fingernail psoriasis and moderate-to-severe plaque psoriasis. Patients were randomized 1:1 to 40mg adalimumab every other week or placebo. The primary efficacy end point was at least 75% improvement in total-fingernail modified Nail Psoriasis Severity Index (NAPSI75) response rate at week 26. Ranked secondary end point scores evaluated at week 26 were total-fingernail NAPSI and modified NAPSI, nail pain, Nail Psoriasis Physical Functioning Severity, Brigham Scalp Nail Inverse Palmo-Plantar Psoriasis Index, and Physician's Global Assessment (fingernail psoriasis). Of the 217 randomized patients (108 received placebo and 109 received adalimumab), 188 (86.6%) completed 26weeks of treatment (period A) or escaped early to the open-label period. The study met the primary end point (response rate of 3.4% with placebo vs 46.6% with adalimumab [P < .001]) and all ranked secondary end points. The serious adverse event rates (placebo vs adalimumab) in period A were 4.6% versus 7.3%; the serious infections rates were 1.9% versus 3.7%. Patients with less than 5% BSA involvement were not eligible for enrollment. After 26weeks of adalimumab treatment, significant improvements were seen in the primary and all ranked secondary end points and in signs and symptoms of moderate-to-severe nail psoriasis versus with placebo and no new safety risks were identified.

Improvement of nail psoriasis with brodalumab in phase 3 trials

Improvement of nail psoriasis with brodalumab in phase 3 trials

A 36-week retrospective open trial comparing the efficacy of biological therapies in nail psoriasis

Nail psoriasis occurs in about 50% of psoriatic patients and can be psychologically devastating since it appears on visible areas. Up to now there is no evidence about what biological drugs is the most effective on nail psoriasis. The aim of our study was to determine if one of the four biological drugs approved in our country (infliximab, adalimumab, etanercept, ustekinumab) is more effective than the others for nail psoriasis. A single-center, retrospective study was conducted to assess the efficacy of biological therapies in patients with moderate to severe psoriasis with nail involvement. NAPSI was evaluated in all psoriatic patients. Kruskal-Wallis and Fisher's exact tests were used to analyze the data. A global statistically significant improvement in mean NAPSI from baseline to 12, 24 and 36 weeks was observed in all patients. At 12 weeks 27.78% of the patients reach NAPSI 75, at 24 weeks 81.48% and at 36 weeks 88.89%. The improvement in nail psoriasis is not significantly different between groups. An improvement in the mean Psoriasis Area and Severity Index score was also achieved Biological therapies have shown to ameliorate psoriatic nail lesions. We did not find any statistically significant differences between the four biological drugs investigated.

Efficacy of adalimumab across subgroups of patients with moderate‐to‐severe chronic plaque psoriasis of the hands and/or feet: post hoc analysis of REACH

BackgroundThe Randomized Controlled Evaluation of Adalimumab in Treatment of Chronic Plaque Psoriasis of the Hands and Feet (REACH) trial demonstrated that adalimumab was efficacious and well-tolerated for the treatment of hand and/or foot psoriasis through 28 weeks.ObjectiveTo evaluate the effects of patient baseline characteristics on efficacy of adalimumab treatment of hand and/or foot psoriasis.MethodsPatients with moderate-to-severe chronic plaque psoriasis of the hands and/or feet were randomized 2: 1 to adalimumab or placebo during the 16 week, double-blind period of REACH. Primary endpoint was percentage of patients achieving Physician’s Global Assessment of the hands and/or feet of clear/almost clear at week 16. Post hoc analyses evaluated effects of baseline patient characteristics on the primary endpoint. Patients with nail psoriasis at baseline were assessed for association of Nail Psoriasis Severity Index (NAPSI) 50 response with efficacy outcomes at week 16.ResultsSeventy-two patients (49 adalimumab: 23 placebo) were analysed. Greater percentages of adalimumab-treated patients achieved the primary endpoint vs. placebo across all subgroups. Among 31 patients with nail psoriasis, a greater percentage of adalimumab-treated patients achieved NAPSI 50 (56.5%) vs. placebo (12.5%) at week 16. In adalimumab-treated patients, greater percentages of NAPSI 50 Responders vs. Non-responders achieved the primary endpoint, and had greater improvements in erythema, scaling, induration and fissuring, Dermatology Life Quality Index, and pain scores.ConclusionsAdalimumab was efficacious in treating chronic plaque psoriasis of the hands and/or feet over 16 weeks, regardless of baseline characteristics. Marked improvement in nail psoriasis among adalimumab-treated patients correlated with significant improvements in skin disease and patient-reported outcomes.

Interventions for nail psoriasis

Psoriasis is a common skin disease that can also involve the nails. All parts of the nail and surrounding structures can become affected. The incidence of nail involvement increases with duration of psoriasis. Although it is difficult to treat psoriatic nails, the condition may respond to therapy. To assess evidence for the efficacy and safety of the treatments for nail psoriasis. We searched the following databases up to March 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched trials databases and checked the reference lists of retrieved studies for further references to relevant randomised controlled trials (RCTs). All RCTs of any design concerning interventions for nail psoriasis. Two authors independently assessed trial risk of bias and extracted the data. We collected adverse effects from the included studies. We included 18 studies involving 1266 participants. We were not able to pool due to the heterogeneity of many of the studies.Our primary outcomes were 'Global improvement of nail psoriasis as rated by a clinician', 'Improvement of nail psoriasis scores (NAS, NAPSI)', 'Improvement of nail psoriasis in the participant's opinion'. Our secondary outcomes were 'Adverse effects (and serious adverse effects)'; 'Effects on quality of life'; and 'Improvement in nail features, pain score, nail thickness,thickness of subungual hyperkeratosis, number of affected nails, and nail growth'. We assessed short-term (3 to 6 months), medium-term (6 to 12 months), and long-term (> 12 months) treatments separately if possible.Two systemic biologic studies and three radiotherapy studies reported significant results for our first two primary outcomes. Infliximab 5 mg/kg showed 57.2% nail score improvement versus -4.1% for placebo (P < 0.001); golimumab 50 mg and 100 mg showed 33% and 54% improvement, respectively, versus 0% for placebo (P < 0.001), both after medium-term treatment. Infliximab and golimumab also showed significant results after short-term treatment. From the 3 radiotherapy studies, only the superficial radiotherapy (SRT) study showed 20% versus 0% nail score improvement (P = 0.03) after short-term treatment.Studies with ciclosporin, methotrexate, and ustekinumab were not significantly better than their respective comparators: etretinate, ciclosporin, and placebo. Nor were studies with topical interventions (5-fluorouracil 1% in Belanyx® lotion, tazarotene 0.1% cream, calcipotriol 50 ug/g, calcipotriol 0.005%) better than their respective comparators: Belanyx® lotion, clobetasol propionate, betamethasone dipropionate with salicylic acid, or betamethasone dipropionate.Of our secondary outcomes, not all included studies reported adverse events; those that did only reported mild adverse effects, and there were more in studies with systemic interventions. Only one study reported the effect on quality of life, and two studies reported nail improvement only per feature. Infliximab, golimumab, SRT, grenz rays, and electron beam caused significant nail improvement compared to the comparative treatment. Although the quality of trials was generally poor, this review may have some implications for clinical practice.Although powerful systemic treatments have been shown to be beneficial, they may have serious adverse effects. So they are not a realistic option for people troubled with nail psoriasis, unless the patient is prescribed these systemic treatments because of cutaneous psoriasis or psoriatic arthritis or the nail psoriasis is severe, refractory to other treatments, or has a major impact on the person's quality of life. Because of their design and timescale, RCTs generally do not pick up serious side-effects. This review reported only mild adverse effects, recorded mainly for systemic treatments. Radiotherapy for psoriasis is not used in common practice. The evidence for the use of topical treatments is inconclusive and of poor quality; however, this does not imply that they do not work.Future trials need to be rigorous in design, with adequate reporting. Trials should correctly describe the participants' characteristics and diagnostic features, use standard validated nail scores and participant-reported outcomes, be long enough to report efficacy and safety, and include details of effects on nail features.

TNF-α antagonists and nail psoriasis: an open, 24-week, prospective cohort study in adult patients with psoriasis

Introduction: Treatment of nail psoriasis can be challenging and unsatisfactory. The aim of this study was to compare the efficacy of three different anti-TNF-α agents on nail psoriasis in patients affected by psoriasis.Materials and methods: Seventy-two patients with nail psoriasis were evaluated in this open, 24 weeks, prospective study. Patients were enrolled in three groups of treatment: adalimumab, etanercept or infliximab. Severity of nail psoriasis was assessed by the Nail Psoriasis Severity Index (NAPSI) at baseline, week 14, and 24.Results: Sixty patients were included in the study. The mean NAPSI was 33.77. In the adalimumab group, the mean NAPSI score was 33.1 (± 14.9) at baseline, 21 (± 8.91) at week 14 and 11.4 (± 4.6) at week 24 (p < 0.0002). In the etanercept group, the mean NAPSI was 34.8 (± 12.38) at baseline, 23.6 (± 10.43) at week 14, and 10.6 (± 5.25) at week 24 (p < 0.0016). In the infliximab group, the mean NAPSI was 33.3 (± 9.76) at baseline, 14.9 (± 4.20) at week 14 (p < 0.001) and 3.1 (± 3.27) at week 24 (p < 0.00001). At week 14 efficacy was higher in infliximab group compared to adalimumab and etanercept groups (p < 0.05).Conclusions: Among the three agents, in the infliximab group a significant improvement in nail psoriasis was observed as early as week 14 of therapy whereas in the adalimumab and etanercept groups at week 24.

„Stiefkind“ Nagelpsoriasis

Approximately 50% of all patients with psoriasis develop characteristic nail changes as a clinical correlate of psoriatic inflammation of the nail matrix and/or nail bed. The most frequent signs of nail psoriasis are pitting and distal onycholysis. The most commonly used score to assess the severity of nail involvement at present is the Nail Psoriasis Severity Index (NAPSI). Although more than half of affected patients experience a significant physical and mental impairment, this index does not include patient-reported symptoms. There is a striking association between nail psoriasis and a higher risk of psoriatic arthritis with a prevalence of nail involvement among patients with psoriatic arthritis as high as 70%. A possible explanation is the close anatomical link between the nail apparatus and the distal interphalangeal joint; enthesitis of the latter is carried by fibers to the nail and becomes clinically visible as nail psoriasis. Nail involvement is not adequately reflected in current concepts of disease management. There is limited evidence for the efficacy of topical therapies in nail psoriasis. A number of large studies document an improvement of nail psoriasis in response to biologics and, more recently, also to methotrexate.

Marked improvement in nail psoriasis during treatment with etanercept

Psoriasis is a chronic inflammatory skin condition that affects approximately 3% of the population. Up to 50% of patients with psoriasis have concurrent nail psoriasis, up to 30% of patients with skin psoriasis also have psoriatic arthritis and of these, approximately 80% have nail disease. The treatment of nail psoriasis is often challenging, and there is a need for new therapeutic options. Effective biological agents used in the treatment of moderate to severe chronic plaque psoriasis may represent a new therapeutic modality for this disease. A case of rapid improvement is reported in nail psoriasis under etanercept monotherapy with maintained efficacy following the withdrawal of continued therapy.

Improvement in nail psoriasis is associated with improved efficacy outcomes in hand and/or foot psoriasis in adalimumab-treated patients: Subanalysis of REACH

Improvement in nail psoriasis is associated with improved efficacy outcomes in hand and/or foot psoriasis in adalimumab-treated patients: Subanalysis of REACH

Nail psoriasis: a retrospective study on the effectiveness of systemic treatments (classical and biological therapy)

Nail psoriasis represents a challenge for specialists. There is no comparative study of systemic treatment's effectiveness at this site. Evaluate the response of nail psoriasis to classical and biological therapy and to compare the effectiveness and safety of the different treatments. We performed a retrospective study of 84 patients with moderate-severe psoriasis seen at our Department between January 2006 and January 2009. Psoriasis was severe in 53.4%. In 75% of cases, the fingernails were affected, and the mixed form was the most frequently subtype. The mean baseline scores on the PASI and the NAPSI were 23.12 and 14.7 respectively; the correlation between the two scores fell at weeks 12 and 24 but had risen again at week 48. The baseline NAPSI score tended to be lower in women and significantly higher in patients over 65 years of age, family history of psoriasis, severe psoriasis and nail matrix involvement. In our series, 58.3% received classical treatment (acitretin, methotrexate, cyclosporin, PUVA, NUVB, REPUVA, RENUVB) and 41.7% received biological treatment (infliximab, efalizumab, etanercept, adalimumab).Significant reductions were found (P < 0.05) in the mean NAPSI scores at 12, 24 and 48 weeks with all the antipsoriatic agents except NUVB; significantly greater with cyclosporine (P < 0.01) and biological as infliximab and adalimumab at 12 and 24 weeks (differences between treatments disappeared at 48 weeks). The response to treatment is slower in the nail lesions than in the skin lesions. The improvement of nail psoriasis is significant both with the classical treatments significantly higher in cyclosporin; and biological treatment (infliximab and adalimumab at 12 and 24 weeks).

Improvement in nail psoriasis with alefacept

Improvement in nail psoriasis with alefacept