secukinumab, etanercept, guselkumab, adalimumab, ixekizumab, and infliximab) and 2 small molecules (apremilast and tofacitinib), all therapies shown to significantly improve nail score compared with placebo in weeks 10 to 16 and weeks 24 to 26.9 According to the SUCRA, tofacitinib was ranked best at weeks 0 to 16, followed by infliximab; and ixekizumab was ranked best at weeks 4 to 28, followed by infliximab. Unfortunately, data regarding tildrakizumab were not included in the metanalysis because of the lack of RCT or case series.9
Our experience with tildrakizumab in nail psoriasis includes only 8 patients, and studies including a larger number of patients are required in order to confirm our observation of fast improvement of nail psoriasis. Tildrakizumab is a molecule that in RCTs (reSURFACE-1 and 2) studies has proved to be efficacious against plaque psoriasis, but not strikingly fast, requiring 20 weeks to achieve the best PASI-improvements in most patients, as confirmed in our 8 patients.1 Nail psoriasis is highly distressing and in severe cases requires prompt treatment.7-10 This report is the first attempt to evaluate and compare the nail response with the rest of the body response in patients that followed tildrakizumab therapy for at least 20 weeks. These data become important if we considered that quality of life impairment is higher in patients affected by nail involvement when compared with psoriasis vulgaris.10
Our experience with tildrakizumab in nail psoriasis includes only 8 patients, and studies including a larger number of patients are required in order to confirm our observation of fast improvement of nail psoriasis. Tildrakizumab is a molecule that in RCTs (reSURFACE-1 and 2) studies has proved to be efficacious against plaque psoriasis, but not strikingly fast, requiring 20 weeks to achieve the best PASI-improvements in most patients, as confirmed in our 8 patients.1 Nail psoriasis is highly distressing and in severe cases requires prompt treatment.7-10 This report is the first attempt to evaluate and compare the nail response with the rest of the body response in patients that followed tildrakizumab therapy for at least 20 weeks. These data become important if we considered that quality of life impairment is higher in patients affected by nail involvement when compared with psoriasis vulgaris.10
DISCLOSURES
The author has no funding sources and no conflicts of interest
to declare.
ACKNOWLEDGMENTS
The patients in this manuscript have given written informed
consent to publication of their case details.
REFERENCES
1. Reich K, Papp KA, Blauvelt A, et al. Tildrakizumab versus placebo or etanercept for chronic plaque psoriasis (reSURFACE 1 and reSURFACE 2): results from two randomised controlled, phase 3 trials. Lancet. 2017;390:276-288.
2. Ismail FF, May J, Moi J, Sinclair R. Clinical improvement in psoriatic nail disease and psoriatic arthritis with tildrakizumab treatment. Dermatol Ther. 2020;33(2):e13216.
3. Megna M, Fabbrocini G, Ruggiero A, Cinelli E. Efficacy and safety of risankizumab in psoriasis patients who failed anti-IL-17, anti-12/23 and/or anti IL-23: Preliminary data of a real-life 16-week retrospective study. Dermatol Ther. 2020;33(6):e14144.
4. Foley P, Gordon K, Griffiths CEM, et al. Efficacy of guselkumab compared with adalimumab and placebo for psoriasis in specific body regions: A secondary analysis of 2 randomized clinical trials. JAMA Dermatol. 2018;154(6):676-683.
5. Blauvelt A, Leonardi C, Elewski B, et al. A head-to-head comparison of ixekizumab vs guselkumab in patients with moderate-to-severe plaque psoriasis: 24-week efficacy and safety results from a randomized, doubleblinded trial. Br J Dermatol. 2021;184(6):1047-1058.
6. Reich K, Sullivan J, Arenberger P, et al. Secukinumab shows high and sustained efficacy in nail psoriasis: 2.5-year results from the randomized placebo-controlled TRANSFIGURE study. Br J Dermatol. 2021;184(3):425- 436.
7. Bardazzi F, Starace M, Bruni F, Magnano M, Piraccini BM, Alessandrini A. Nail Psoriasis: An Updated Review and Expert Opinion on Available Treatments, Including Biologics. Acta Derm Venereol. 2019;99(6):516-523.
8. Elewski B, Rich P, Lain E, et al. Efficacy of brodalumab in the treatment of scalp and nail psoriasis: results from three phase 3 trials. J Dermatolog Treat. 2022;33(1):261-265. doi:10.1080/09546634.2020.1749546
9. Huang IH, Wu PC, Yang TH, et al. Small molecule inhibitors and biologics in treating nail psoriasis: A systematic review and network meta-analysis. J Am Acad Dermatol. 2021;85(1):135-143.
10. Stewart CR, Algu L, Kamran R, et al. The impact of nail psoriasis and treatment on quality of life: A systematic review. Skin Appendage Disord. 2021;7(2):83-89.
2. Ismail FF, May J, Moi J, Sinclair R. Clinical improvement in psoriatic nail disease and psoriatic arthritis with tildrakizumab treatment. Dermatol Ther. 2020;33(2):e13216.
3. Megna M, Fabbrocini G, Ruggiero A, Cinelli E. Efficacy and safety of risankizumab in psoriasis patients who failed anti-IL-17, anti-12/23 and/or anti IL-23: Preliminary data of a real-life 16-week retrospective study. Dermatol Ther. 2020;33(6):e14144.
4. Foley P, Gordon K, Griffiths CEM, et al. Efficacy of guselkumab compared with adalimumab and placebo for psoriasis in specific body regions: A secondary analysis of 2 randomized clinical trials. JAMA Dermatol. 2018;154(6):676-683.
5. Blauvelt A, Leonardi C, Elewski B, et al. A head-to-head comparison of ixekizumab vs guselkumab in patients with moderate-to-severe plaque psoriasis: 24-week efficacy and safety results from a randomized, doubleblinded trial. Br J Dermatol. 2021;184(6):1047-1058.
6. Reich K, Sullivan J, Arenberger P, et al. Secukinumab shows high and sustained efficacy in nail psoriasis: 2.5-year results from the randomized placebo-controlled TRANSFIGURE study. Br J Dermatol. 2021;184(3):425- 436.
7. Bardazzi F, Starace M, Bruni F, Magnano M, Piraccini BM, Alessandrini A. Nail Psoriasis: An Updated Review and Expert Opinion on Available Treatments, Including Biologics. Acta Derm Venereol. 2019;99(6):516-523.
8. Elewski B, Rich P, Lain E, et al. Efficacy of brodalumab in the treatment of scalp and nail psoriasis: results from three phase 3 trials. J Dermatolog Treat. 2022;33(1):261-265. doi:10.1080/09546634.2020.1749546
9. Huang IH, Wu PC, Yang TH, et al. Small molecule inhibitors and biologics in treating nail psoriasis: A systematic review and network meta-analysis. J Am Acad Dermatol. 2021;85(1):135-143.
10. Stewart CR, Algu L, Kamran R, et al. The impact of nail psoriasis and treatment on quality of life: A systematic review. Skin Appendage Disord. 2021;7(2):83-89.
AUTHOR CORRESPONDENCE
Alexandra M.G. Brunasso MD Giovanna.brunasso@gmail.com
