Efficacy of Biologics Targeting Tumour Necrosis Factor-alpha, Interleukin-17 -12/23, -23 and Small Molecules Targeting JAK and PDE4 in the Treatment of Nail Psoriasis: A Network Meta-analysis

Abstract

The comparative efficacy of registered anti-psoriatic biologics and small molecules in treating nail symptoms has not been systematically evaluated. The aim of this study was to perform a network meta-analysis to determine the efficacy of biologics and small molecules in nail psoriasis. A Bayesian network meta-analysis of 17 randomized clinical trials (a total of 6,053 nail psoriatic patients) was performed, comparing the short-term (week 10–16) efficacy of biologics and small molecules in the treatment of nail psoriasis. All active treatments were found to be superior to placebo. Ixekizumab 80 mg every 4 weeks (Nail Psoriasis Severity Index (NAPSI) % improvement, Surface Under the Cumulative Ranking (SUCRA)=0.92) and etanercept 50 mg twice weekly (probability of achieving NAPSI 50, SUCRA=0.82) proved the best short-term treatment options. However, efficacy end-points in psoriasis trials were not optimized for nail assessment, and outcome parameters were highly heterogeneous, limiting comparability. In conclusion, outcome parameters and efficacy endpoints of nail psoriasis trials should be standardized.

Network meta-analysis comparing the efficacy of biologic treatments for achieving complete resolution of nail psoriasis

“…This study compares the relative efficacy of biologics in achieving complete clearance of NP in patients with moderate-tosevere psoriasis at weeks 24-26, and the IL-17A inhibitor ixekizumab has the highest probability of being ranked best. Ixekizumab also had the highest ranking in a recent NMA of biologics and small molecules in treating NP (27). However, our NMA evaluated results at 24-26 weeks, whereas this analysis compared short-term efficacy at week 10-16, which was generally too short a time period to adequately assess nail outcomes (3), and treatment efficacy was based on NAPSI improvement rather than complete nail resolution (27).…”

“…Ixekizumab also had the highest ranking in a recent NMA of biologics and small molecules in treating NP (27). However, our NMA evaluated results at 24-26 weeks, whereas this analysis compared short-term efficacy at week 10-16, which was generally too short a time period to adequately assess nail outcomes (3), and treatment efficacy was based on NAPSI improvement rather than complete nail resolution (27). Results from the current study confirm and extend that biologics approved for the treatment of psoriasis are efficacious in achieving complete resolution of NP after 24-26 weeks in comparison with placebo and that ixekizumab had significantly higher response rates (i.e.…”

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].…”

Narrative Review of the Emerging Therapeutic Role of Brodalumab in Difficult-to-Treat Psoriasis

“…Recent reviews and guidelines have highlighted the efficacy of biologics in nail psoriasis treatment [ 32 , 33 ]. Biologics such as TNFα inhibitors have been recommended for severe or worsening nail lesions that are uncontrolled with topical or conventional systemic therapies, with or without concomitant psoriatic joint disease [ 3 , 28 ].…”