Efficacy of Systemic Treatments of Nail Psoriasis: A Systemic Literature Review and Meta-Analysis

Abstract

Importance: Nail involvement is a common condition in patients with psoriasis. The treatment of nail psoriasis is considered challenging and is often left untreated by physicians.Objective: To assess the efficacy of current systemic treatments on nail psoriasis.Data Sources: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant articles from inception to September 1, 2020. Included articles were restricted to English language and human studies.Study Selection: This was a systematic literature review with meta-analysis. Thirty-five random control trials that evaluated systemic therapies for nail psoriasis were selected in the systemic review. Among them, we retained 14 trials for meta-analysis.Data Extraction and Synthesis: This study was conducted in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. All steps were performed by two independent investigators, and any disagreements were resolved by a third investigator. Meta-analysis of aggregated study data was conducted to assess therapeutic efficacy. The use of random-effects model was based on high heterogeneity as a variable endpoint in different studies.Main Outcomes and Measures: Therapeutic effects on nail psoriasis were expressed in terms of effect sizes with 95% CIs.Results: We included 35 random control trials (RCTs) in this systemic review. At baseline, a high prevalence (62.1%) of nail psoriasis was confirmed. The meta-analysis included 14 trials highlighting that biologic and small-molecule therapies were effective in treating nail psoriasis with variable effect size magnitudes [−0.89 (−1.10, −0.68), I2 = 84%]. In particular, tofacitinib and ixekizumab showed the most significant scale of effect size magnitudes in treating nail psoriasis (−1.08 points and −0.93 points, respectively). We also found that a higher dose of tofacitinib and ixekizumab had similar effectiveness, and anti-IL-17 agents seem to be superior in effectiveness compared to anti-TNF-α therapies in the treatment of nail psoriasis. However, these results must be displayed carefully as variable endpoints in different studies.Conclusions and Relevance: This study provides a comprehensive overview of systemic treatments for nail psoriasis. For patients with psoriatic nail damage who are candidates of systemic therapies, the priority should be given to administering biologic and small-molecule therapies, especially anti-IL-17 drugs.

Psoriasis in areas difficult to treat and biological therapy

“…Recently published systematic reviews and metaanalyzes confirm that all biological and small molecule drugs used in psoriasis resulted in clinical improvement in nail lesions at weeks 10-16 and in weeks 24-26 of treatment compared to placebo. The best results were observed with ixekizumab, etanercept and tofacitinib [35][36][37]. Complete disappearance of symptoms is most likely after treatment with ixekizumab, followed by brodalumab, adalimumab, guselkumab, ustekinumab and infliximab [38].…”

“…This group of drugs seems to provide optimal control of psoriasis Opublikowane ostatnio przeglądy systematyczne i metaanalizy potwierdzają, że wszystkie stosowane w łuszczycy leki biologiczne i drobnocząsteczkowe skutkują poprawą kliniczną w zakresie zmian paznokci w 10.-16. tygodniu i 24.-26. tygodniu leczenia w porównaniu z placebo. Najlepsze wyniki zaobserwowano podczas podawania iksekizumabu, etanerceptu i tofacytynibu [35][36][37]. Całkowite ustąpienie objawów jest najbardziej prawdopodobne po leczeniu iksekizumabem, a w dalszej kolejności brodalumabem, adalimumabem, guzelkumabem, ustekinumabem i infliksymabem [38].…”

Nail psoriasis: dynamics of the clinical course during anti-IL-17 therapy

“…Согласно литературным данным, различные представители группы ингибиторов ИЛ-17, одобренные для терапии псориаза и псориатического артрита, показывают высокую эффективность в отношении клинических проявлений псориатической ониходистрофии [29].…”

Nail Psoriasis and Quality-of-Life Measurement in Clinical Trials: Call for the Use of Nail-Specific Instruments

“…However, the analysis shows that efficacious medication for NPso is available. Another recent meta-analysis [ 11 ] found tofacitinib and ixekizumab to effectively reduce clinical severity of NPso. Again, comparability was limited due to the different endpoints and outcome instruments used, with some studies even having to be excluded from the meta-analysis for this reason.…”