Sustained Resolution of Nail Psoriasis Through 5 Years with Ixekizumab: A Post-Hoc analysis from UNCOVER-3
Keywords:nail, psoriasis, ixekizumab, NAPSI, adult, UNCOVER
Nail psoriasis is a chronic, difficult-to-treat condition affecting almost half of patients with psoriasis. It is associated with considerable social stigma and impairment of patients’ quality of life. The aim of this study was to assess improvements in objective measures of nail psoriasis among patients from the long-term extension of the UNCOVER-3 study who received the interleukin-17A inhibitor ixekizumab and had either any degree of nail psoriasis (Nail Psoriasis Severity Index (NAPSI) >=1) or significant nail psoriasis (fingernail NAPSI ≥ 16 and ≥ 4 fingernails involved) at baseline. Efficacy outcomes reported through week 264 included the mean percentage improvements from baseline in NAPSI score and the proportion of patients achieving nail psoriasis resolution (NAPSI=0). In UNCOVER-3, 56.9% (219/385) of patients had nail psoriasis at baseline; of those, 61.2% (134/219) had significant nail psoriasis. At week 60, a total of 66.9% and 59.1% of patients with baseline nail psoriasis and significant baseline nail psoriasis, respectively, reported complete clearance of nail psoriasis, an effect which was sustained through week 264. This analysis demonstrates that continuous treatment with ixekizumab in adult patients with moderate-to-severe-psoriasis through 264 weeks was associated with improvements and clearance of fingernail psoriasis, irrespective of the severity of nail psoriasis at baseline.
Haneke E. Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management. Psoriasis (Auckl) 2017; 7: 51-63.
Blome C, Augustin M, Klein TM. Nail psoriasis and quality-of-life measurement in clinical trials: call for the use of nail-specific instruments. Am J Clin Dermatol 2021; 22: 747-755.
Gisondi P, Bellinato F, Targher G, Idolazzi L, Girolomoni G. Biological disease-modifying antirheumatic drugs may mitigate the risk of psoriatic arthritis in patients with chronic plaque psoriasis. Ann Rheum Dis 2022; 81: 68-73.
Paller AS, Seyger MMB, Alejandro Magarinos G, Bagel J, Pinter A, Cather J, et al. Efficacy and safety of ixekizumab in a phase III, randomized, double-blind, placebo-controlled study in paediatric patients with moderate-to-severe plaque psoriasis (IXORA-PEDS). Br J Dermatol 2020; 183: 231-241.
Craig S, Warren RB. Ixekizumab for the treatment of psoriasis: up-to-date. Expert Opin Biol Ther 2020; 20: 549-557.
Blauvelt A, Lebwohl MG, Mabuchi T, Leung A, Garrelts A, Crane H, et al. Long-term efficacy and safety of ixekizumab: A 5-year analysis of the UNCOVER-3 randomized controlled trial. J Am Acad Dermatol 2021; 85: 360-368.
Seyger MMB, Reich A, El Baou C, Schuster C, Riedl E, Paller AS. Efficacy of ixekizumab on nail psoriasis in paediatric patients with moderate-to-severe psoriasis: a post hoc analysis from IXORA-PEDS. J Eur Acad Dermatol Venereol 2021; 35: e911-e913.
Wasel N, Thaci D, French LE, Conrad C, Dutronc Y, Gallo G, et al. Ixekizumab and ustekinumab efficacy in nail psoriasis in patients with moderate-to-severe psoriasis: 52-week results from a phase 3, head-to-head study (IXORA-S). Dermatol Ther (Heidelb) 2020; 10: 663-670.
Blauvelt A, Leonardi C, Elewski B, Crowley JJ, Guenther LC, Gooderham M, et al. A head-to-head comparison of ixekizumab vs. guselkumab in patients with moderate-to-severe plaque psoriasis: 24-week efficacy and safety results from a randomized, double-blinded trial. Br J Dermatol 2021; 184: 1047-1058.
Reich K, Conrad C, Kristensen LE, Smith SD, Puig L, Rich P, et al. Network meta-analysis comparing the efficacy of biologic treatments for achieving complete resolution of nail psoriasis. J Dermatolog Treat 2022; 33: 1652-1660.
Augustin M, Reich K, Blome C, Schafer I, Laass A, Radtke MA. Nail psoriasis in Germany: epidemiology and burden of disease. Br J Dermatol 2010; 163: 580-585.
Temiz SA, Ozer I, Ataseven A, Dursun R, Uyar M. The effect of smoking on the psoriasis: Is it related to nail involvement? Dermatol Ther 2020; 33: e13960.
Armstrong AW, Armstrong EJ, Fuller EN, Sockolov ME, Voyles SV. Smoking and pathogenesis of psoriasis: a review of oxidative, inflammatory and genetic mechanisms. Br J Dermatol 2011; 165: 1162-1168.
Acosta Felquer ML, LoGiudice L, Galimberti ML, Rosa J, Mazzuoccolo L, Soriano ER. Treating the skin with biologics in patients with psoriasis decreases the incidence of psoriatic arthritis. Ann Rheum Dis 2022; 81: 74-79.
Reich K, Kristensen LE, Smith SD, Rich P, Sapin C, Liu-Leage S, et al. Efficacy and safety of ixekizumab versus adalimumab in biologic-naïve patients with active psoriatic arthritis and moderate-to-severe psoriasis: 52-week results from the randomized SPIRIT-H2H trial. Dermatol Pract Concept 2022; 12: e2022104.
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Copyright (c) 2022 Alexander Egeberg, Lars Erik Kristensen, Ronald Vender, Shirin Zaheri, Celine El Baou, Gaia Gallo, Elisabeth Riedl, Christopher Schuster
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