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
Júlia Szebényi, Noémi Gede, Péter Hegyi, Zsolt Szakács, Margit Solymár, Bálint Erőss, András Garami, Kornélia Farkas, Dezső Csupor, Rolland Gyulai
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.
Psoriasis, a chronic inflammatory skin disease, often affects the nails. Nail psoriasis is an embarrassing condition that presents a therapeutic challenge. New treatments, such as the so-called biological therapies, are highly effective in treating psoriatic skin symptoms. Although many of these treatments have proved useful in treating nail symptoms, to date, their efficacy for treating nail psoriasis has not been determined. This study systematically analysed and compared the short-term efficacy of the new medications used for treating nail psoriasis, and determined their therapeutic ranking based on the probability of the treatment improving psoriatic nail symptoms.