Recent findings from the ongoing ‘Psoriasis Study of Health Outcomes’ (PSoHO) indicate that individuals with moderate-to-severe psoriasis and concurrent nail psoriasis experience significant and rapid improvements in modified Nail Psoriasis Severity Index (mNAPSI) scores when treated with anti-interleukin (IL)-17A biologics compared to other approved biologics.
Led by Elisabeth Riedl of the Medical University of Vienna, the PSoHO study is a prospective, non-interventional cohort investigation focusing on subjects with chronic moderate-to-severe plaque psoriasis who either initiated or switched to a new biologic treatment.
The study’s analysis specifically compared the efficacy of anti-IL-17A biologics against other biologics, including ixekizumab versus secukinumab (SEC), guselkumab (GUS), risankizumab (RIS), and adalimumab (ADA), in terms of nail psoriasis improvement over the first 12 months in a real-world setting.
Research Methodology and Outcomes
The research team utilized consistent methodology from previous PSoHO analyses, assessing shifts in mNAPSI scores among study participants over 12 months. The mNAPSI assessment was refined to enhance both its practicality and credibility as a diagnostic tool.
Scores were assigned based on a 0-3 scale for specific nail features (pitting, onycholysis, oil-drop dyschromia, crumbling) and scored as 1 if present and 0 if absent for other features (leukonychia, hyperkeratosis, splinter hemorrhages, red spots in the lunula). Scores ranged from 0 to 13 per fingernail and 0 to 130 across all ten fingernails, with assessments limited to participants’ hands.
Key Findings
The study revealed significant and accelerated improvements in nail psoriasis among subjects treated with anti-IL-17A biologics compared to other biologics at months 3 and 6, regardless of initial disease severity. This aligns with earlier findings indicating higher rates of nail clearance within three months among those treated with anti-IL-17A therapies.
Specifically, ixekizumab demonstrated statistically significant improvements over guselkumab up to the 12-month mark for any level of nail psoriasis. For individuals with moderate-to-severe disease, disparities were also observed compared to guselkumab at all time points measured and against risankizumab by the 6-month mark.
Conclusion
The study suggests that ixekizumab, an IL-17A inhibitor, may provide faster and more pronounced amelioration of nail psoriasis compared to IL-23 antibody guselkumab, particularly over the initial 12 months of treatment. These findings may guide physicians in treatment decisions for patients with psoriasis and concomitant nail involvement, paving the way for further real-world investigations into this challenging condition.
