Anti-IL-17A Biologics Superior in Treating Patients with Psoriasis, Concomitant Nail Psoriasis

Individuals with moderate-to-severe psoriasis and concomitant nail psoriasis involvement may see substantial and faster improvements in modified Nail Psoriasis Severity Index (mNAPSI) scores when treated with anti-interleukin (IL)-17A biologics compared to other approved biologics, according to new findings.¹

These results were the conclusions of the 3-year ‘Psoriasis Study of Health Outcomes’ (PSoHO) study. The ongoing study, led by Elisabeth Riedl of the Medical University of Vienna, uses a prospective, non-interventional cohort design, with the investigators looking at subjects with chronic moderate-to-severe plaque psoriasis beginning or switching to a new biologic.²

“This analysis compares the effectiveness of the anti-interleukin (IL)-17A cohort versus the other biologics cohort, as well as ixekizumab versus secukinumab (SEC), guselkumab (GUS), risankizumab (RIS) and adalimumab (ADA) in terms of improvements in NP up to month 12 within a real-world setting,” Reidl and colleagues wrote.

Background and Methods

The research team used a methodology which was consistent with prior analyses in the PSoHO study. They assessed shifts in study participants’ mNAPSI scores over a period lasting 12 months, with the mNAPSI assessment being designed to improve both the practicality and credibility of the tool as an assessment mechanism.

The investigators graded, on a 0 - 3 scale for each fingernail, 3 specific features: pitting, onycholysis and oil-drop dyschromia, and crumbling. They also had 4 other features (leukonychia, hyperkeratosis, splinter hemorrhages, and red spots found in the lunula) scored as either 1 if visible and 0 if absent on each nail.

Participants’ mNAPSI scores had a range from 0 - 13 for each fingernail and from 0 - 130 for all 10 fingernails. The investigators noted that only the hands of subjects were evaluated in their assessment of nail psoriasis.

Two distinct cohorts were delineated by the investigators based on participants’ mNAPSI fingernail scores at the study’s initiation: the first was individuals with any degree of nail psoriasis (mNAPSI ≥ 1), and the second was individuals that had moderate-to-severe nail psoriasis (mNAPSI ≥ 20).

The anti-IL-17A treatment arn was compared to another biologics group, and specifically, ixekizumab was compared to various biologics with the necessary sample sizes needed to find meaningful comparisons.

The investigators looked into information on participants given biologics based upon the on-label dosing that has been recommended by the European Medicines Agency (EMA). A sensitivity analysis was also conducted.

Findings

Overall, these data point to notable and accelerated enhancements in subjects’ nail psoriasis at months 3 and 6 when treated with anti-IL-17A biologics, in contrast to other biologic treatments, regardless of their condition’s initial severity. These results echo a prior analysis from the same study, which had shown that those in the anti-IL-17A arm showed far greater chances of nail clearance by the 3-month mark.

In the current analysis, ixekizumab was shown by the investigators to have led to a statistically significant improvement in nail psoriasis over guselkumab up to the 12-month mark for any level of nail psoriasis. The research team also found that for those with moderate-to-severe disease, there were disparities similarly observed compared to guselkumab at all measured time points, as well as against risankizumab by the 6-month mark.

In each of the treatment cohorts, the investigators found that those with moderate-to-severe nail psoriasis (baseline mNAPSI ≥ 20) showed large numerical enhancements in the participants’ mNAPSI scores versus individuals with any degree of nail psoriasis (baseline mNAPSI ≥ 1).

While there had not been statistically significant variations in real-world effectiveness among infliximab, etanercept, adalimumab, and ustekinumab in a prior comparative study, this current study’s results suggested a quicker and more pronounced amelioration in patients’ nail psoriasis up to 12 months using the IL-17A inhibitor ixekizumab, contrasting with the IL-23 antibody guselkumab.

“Irrespective of NP severity, IXE-treated patients showed the greatest numerical improvements from baseline in mNAPSI scores at month 12,” they wrote. “These results may support physicians in their treatment decisions for patients with PsO and concomitant NP and may serve as a foundation for further real-world studies of this difficult-to-treat condition.”

References

1. ^{Riedl, E., Pinter, A., Zaheri, S. et al. Baseline Characteristics and mNAPSI Change from Baseline Scores Through Month 12 for Patients with Moderate-to-Severe Plaque Psoriasis and Concomitant Nail Psoriasis Treated with Biologics from PSoHO. Dermatol Ther (Heidelb) (2024). https://doi.org/10.1007/s13555-024-01150-y.}
2. ^{Pinter A, Costanzo A, Khattri S, et al. Comparative effectiveness and durability of biologics in clinical practice: month 12 outcomes from the International, Observational Psoriasis Study of Health Outcomes (PSoHO). Dermatol Ther (Heidelb). 2023. https://doi.org/10.1007/s13555-023-01086-9.}