Sustained Resolution of Nail Psoriasis Through 5 Years with Ixekizumab: A Post-Hoc analysis from UNCOVER-3

Abstract

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 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 during 264 weeks was associated with improvements and clearance of fingernail psoriasis, irrespective of the severity of nail psoriasis at baseline.

A Comprehensive Review of Ixekizumab Efficacy in Nail Psoriasis from Clinical Trials for Moderate-to-Severe Psoriasis and Psoriatic Arthritis

“…Additionally, findings from IXORA-PEDS demonstrated improvements in nail psoriasis of both the nail bed and nail matrix regions with only marginally slower responses observed in the nail matrix compared to the nail bed [ 23 ]. In UNCOVER-3, similar findings were reported in adult patients with moderate-to-severe psoriasis [ 24 ].…”

“…In IXORA-PEDS, a lower proportion of patients had nail psoriasis at baseline and unlike all other studies reviewed, IXORA-PEDS included only pediatric patients. Considering severity of nail disease, a similar proportion of patients presented with significant nail psoriasis (NAPSI score ≥ 16 with the involvement of at least four nails) across UNCOVER-3, IXORA-S and IXORA-PEDS [ 22 – 24 ]. In IXORA-R, 16% of IXE and 12% of guselkumab (GUS) patients had moderate-to-severe nail psoriasis as determined by a PGA-F score ≥ 3 [ 25 ].…”

“…In UNCOVER-3, further mean change from baseline improvement in NAPSI scores was reported for patients with baseline and significant baseline (85.3%) nail psoriasis by week 60 (Fig. 1 ) [ 24 , 29 ]. Long-term extension demonstrated that these improvements were maintained up to 264 weeks for patients with baseline and significant baseline (87.6%) nail psoriasis (Fig.…”

“…Long-term extension demonstrated that these improvements were maintained up to 264 weeks for patients with baseline and significant baseline (87.6%) nail psoriasis (Fig. 1 ) [ 24 ].…”

“…1 )[ 44 ]. Similarly, 59.1 and 65.5% of patients with significant baseline nail psoriasis had achieved complete clearance of nail psoriasis at week 60 and week 264, respectively, demonstrating long-term efficacy of IXE in clearing nail psoriasis [ 24 ].…”