Efficacy of Ustekinumab in Nail Psoriasis and Improvement in Nail-Associated Quality of Life in a Population Treated with Ustekinumab for Cutaneous Psoriasis: An Open Prospective Unblinded Study

Abstract

Background: The objective of this open-label prospective unblinded study was to evaluate the efficacy of ustekinumab in nail psoriasis and the improvement of patient quality of life (QoL). Methods: Twenty-seven patients with plaque psoriasis and fingernail involvement were treated with the standard ustekinumab regimen. Outcome measures were assessed at baseline and at weeks 4, 16, 28 and 40 using the nail psoriasis severity index (NAPSI). QoL was evaluated before and after treatment using the international onychomycosis-specific questionnaire. Results: The pairwise comparisons showed statistically significant NAPSI reduction in 4, 16, 28 and 40 weeks compared to the baseline score. The mean NAPSI at week 40 was 2.00 ± 2.337. The international onychomycosis QoL scores were significantly improved at all time points (p < 0.001). No patient reported any adverse events. Conclusions: Even though no control group was used in this study, ustekinumab was effective and safe in the treatment of nail psoriasis.

Ustekinumab Treatment of TNF Antagonist-Induced Paradoxical Psoriasis Flare in a Patient with Psoriatic Arthritis: Case Report and Review

“…The efficacy of ustekinumab on nail involvement in our patient also provides further confirmation to previously published case reports [21] and non-randomized studies [22,23], but the reported improvement with respect to placebo at week 12 did not reach statistical significance in Japanese patients involved in a phase II/III clinical trial [24]. …”

Nail psoriasis: a review of the literature

“…49 The drug was also found to be safe and effective in a study of 27 patients, although this particular investigation did not involve a control group. 50 …”

Enthesitis in Psoriatic Disease

“…This is particularly true if the treatment of enthesitis can mitigate future deterioration. Additionally, given the strong link between nail disease and enthesopathy, we must now consider the fact that the efficacy of TNFi and the emerging efficacy of ustekinumab [75] in nail disease depend to some degree on an effect on underlying clinically unrecognized enthesitis of small insertions at and adjacent to the nail. Furthermore, perhaps an imaging-based outcome could be used to address the role of ‘microenthesitis’ in the resolution of the disease [50].…”