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

Abstract

Background: Nail psoriasis (NP) is common and of high importance in patients with psoriasis. Complete resolution of NP at week 24-26 is an unambiguous nail outcome accessible for indirect treatment comparison of biologics. Objective: To evaluate the comparative efficacy of approved biologics in achieving complete resolution of NP at week 24-26. Methods: A network meta-analysis (NMA) was conducted to indirectly compare the efficacy of six biologics in achieving complete resolution of NP at week 24-26 in patients with moderate-to-severe psoriasis and concomitant NP. Complete resolution of NP was defined as a score of zero on the Nail Psoriasis Severity Index (NAPSI), modified NAPSI (mNAPSI) or Physician's Global Assessment of Fingernails (PGA-F). Results: The probability of achieving complete resolution of NP was highest for ixekizumab (46.

Efficacy of ixekizumab on nail psoriasis in paediatric patients with moderate‐to‐severe psoriasis: a post hoc analysis from IXORA‐PEDS

“…In adults, through both direct and indirect comparisons, IXE has demonstrated rapid and/or long-term efficacy in NP 5,8,9 and ranked best among investigated biologics in terms of improvement in nail scores and complete clearance for NP at weeks 24-26, respectively. 7,10 Consistent with the data from adult studies, half of paediatric patients upon treatment with IXE achieved complete clearance in their NP irrespective of disease severity at baseline, confirming and extending the efficacy of IXE in NP to the paediatric population. Furthermore, these results demonstrate the efficacy of IXE in improving both nail matrix and nail bed psoriasis.…”

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

“…As a consequence, outcomes are only comparable between a subset of trials, which hinders interpretability, but also hampers meta-analyses and indirect comparisons of treatments. With the last-named analysis, one can compare the effectiveness of two different interventions even though they have not been assessed in a head-to-head trial [10,29]. This is possible if both treatments have been tested against the same, third, intervention, which then serves as a common comparator.…”

“…In recent years, targeted systemic treatments such as secukinumab have been shown to improve both clinical NPso severity and health-related quality of life (HRQoL) [ 9 ]. In a recent network meta-analysis, six biologics were compared in terms of probability of achieving complete clinical resolution of NPso about half a year after treatment initiation [ 10 ]. Outcomes differed greatly between medications, ranging from 0.8% for infliximab to 46.5% for ixekizumab.…”

Psoriasis in areas difficult to treat and biological therapy

“…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]. Results of the UNCOVER-3 study deserve attention: in patients using ixekizumab, a significant effect was seen in the week 12 of the therapy, and in over 50% of cases remission of nail psoriasis was achieved in the week 60 of the treatment [39].…”

“…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]. Na uwagę zasługują wyniki badania UNCOVER-3: u pacjentów stosujących iksekizumab znaczący efekt był widoczny w 12. tygodniu terapii i w ponad 50% przypadków osiągnięto remisję łuszczycy paznokci w 60. tygodniu leczenia [39].…”