mean PASI was 2.1 (84% improvement), and the mean mNAPSI was 5.1 (90% improvement). Comparative PASI and mNAPSI scores-evolution are shown in Figure 1.
The aim of this real-life report is to underline the unexpectedly fast improvement of the nail psoriasis in the 8 patients, considering that evidence regarding nail improvement during tildrakizumab is scarce.1,2 (Figure 2).
Tildrakizumab is a humanized monoclonal antibody that targets the p19 subunit of IL-23, approved to treat moderate to severe psoriasis.1 Regarding nail psoriasis, a case report documented the efficacy.2 A Phase 3b clinical trial is currently under way (NCT03897075) and results have not yet been published. Regarding other anti-IL-23 available molecules, 2 patients treated with risankizumab registered a mean NAPSI improvement of 11% at week 4 and 61% at week 16.3 Guselkumab efficacy in nail psoriasis has been evaluated in a secondary analysis of 2 randomized controlled trials (RCT) reporting an improvement of 37.5% of NAPSI at week 6 and a NAPSI-improvement of 52.9% vs 51.2% in the adalimumab treated group at week 4.4 The IXORA-R study compared nail responses between ixekizumab and guselkumab at week 4 obtaining a PGA-F of clear or minimal nail psoriasis in 75% (62/83) vs 54% (32/59), P=0.02, demonstrating the fast onset of effect of ixekizumab.5 The TRANSFIGURE trial evaluated the efficacy of secukinumab 150 mg and 300 mg in nail psoriasis: a higher efficacy was observed on the 300 mg arm with a 43.5% of NAPSI improvement at week 6 and 71.5% at week 80, confirming the slow and progressive improvement of the nail involvement during treatment in contrast with the response of plaque psoriasis that affects the skin where the degree of improvement is higher at week 6 and tends slowly to decrease during time.6,7 The same increasing improvement during time was demonstrated during brodalumab vs ustekinumab in 3 RCT (AMAGINE-1/-2/-3), where the mean- NAPSI improvement at week 2 was 43.4% for brodalumab vs 31.8% for ustekinumab, 58.9% vs 76.9% at week 4, and 83% vs 75% at week 52 (P<0.05%).7,8
Recently a network-meta-analysis has been performed comparing 39 studies including 15,673 patients with nail psoriasis treated with 9 biologic treatments (ustekinumab, efalizumab,
