Treatment of Nail Psoriasis: Common Concepts and New Trends

Table 3

Biologic therapies for treatment of nail psoriasis.

Author	Year	𝑛	Intervention	Comparison	Protocol	Results	LoE [16]
Fabroni et al. [55]	2011	48	Infliximab	—	5 mg/kg, iv infusion at weeks 0, 2, 6 and every 8 weeks through week 38	NAPSI-50 is achieved in 85% of patients at week 14, 96% at week 22, 98% at week 38; NAPSI-75 is achieved in 23% of patients at week 14, 65% at week 22, 81% at week 38; NAPSI-90 is achieved in 29% of patients at week 38	N/A
Rich et al. [54]	2008	305	Infliximab	Placebo	5 mg/kg, iv infusion at weeks 0, 2, 6 and every 8 weeks through week 46	26% and 57% improvements in NAPSI scores at weeks 10 and 24 and complete clearance of target nail in 45% of patients at 1 year	A2
Rigopoulos et al. [56]	2008	18	Infliximab	—	5 mg/kg iv infusion at weeks 0, 2, 6 and every 8 weeks through week 38	Significant decrease in NAPSI scores (56 at baseline to 30 at week 14, 16 at week 22, 7 at week 30, and 3.3 at week 38)	N/A
Bianchi et al. [53]	2005	25	Infliximab	—	5 mg/kg, iv, at weeks 0, 2, 6, 14, 22	NAPSI-50 is achieved in all patients at week 14; NAPSI-75 is achieved in all patients at week 22	N/A
Leonardi et al. [57]	2011	36	Adalimumab	Placebo	80 mg, sc at week 0, 40 mg every other week starting at week 1, through week 16; patients in the placebo group were started to receive active treatment starting at week 16, through week 28	Significantly higher improvement in NAPSI scores in the treatment arm (50% versus 8%) at week 16; once switched to adalimumab, patients in the initial placebo group improved 38% at week 28, while patients who began the study with adalimumab continued to improve to 54%	N/A
Van den Bosch et al. [58]	2010	259	Adalimumab	—	40 mg, sc, at every other week through week 12	Mean NAPSI scores are reduced by 44% at week 12	N/A
Rigopoulos et al. [59]	2010	21	Adalimumab	—	80 mg, sc at week 0, 40 mg every other week starting at week 1, through week 24	Significant improvement in all patients after 8th injection; fingernail NAPSI decreased from 11 at baseline to 4 at week 24 in patients with just cutaneous psoriasis and from 24 to 10 in patients with psoriatic arthritis	N/A
Ortonne et al. [60]	2012	69	Etanercept	Etanercept	1st group 50 mg weekly for 24 weeks and 2nd group 50 mg twice weekly for the first 12 weeks, 50 mg weekly for the other 12 weeks, sc	Both dose regimens are effective for nail psoriasis and significant improvement in NAPSI scores in both groups at week 24	N/A
Luger et al. [61]	2009	564	Etanercept	—	25 mg twice weekly for 54 weeks or 50 mg twice weekly for 12 weeks, continued with 25 mg twice weekly in case of relapse, sc	NAPSI scores improved by 29% at week 12, by 51% at week 54, complete resolution in 30% of patients	N/A
Kavanaugh et al. [62]	2009	287	Golimumab	Placebo	50 or 100 mg, sc, every 4 weeks through week 24	Significant improvements started as early as at week 14: 25% reduction in NAPSI scores in 50 mg group, 43% reduction in 100 mg group at week 14, 33% reduction in 50 mg, and 54% reduction in 100 mg group at week 24	B
Körver et al. [63]	2006	8	Alefacept	—	15 mg weekly, im, for 12 weeks	3 patients showed significant improvement, 3 patients unchanged, and 2 patients worsened	N/A
Parrish et al. [64]	2006	15	Alefacept	—	15 mg weekly, im, for 12 weeks	39% reduction in NAPSI scores at week 24	N/A
Cassetty et al. [65]	2005	6	Alefacept	—	15 mg weekly, im, for 12 weeks	3 patients showed ≥30% improvement in NAPSI scores, 1 unchanged, and 2 worsened	N/A
Patsatsi et al. [66]	2013	27	Ustekinumab	—	45 mg, sc, at weeks 0, 4 and every 12 weeks thereafter (90 mg if patient weight > 100 kg)	Significant improvements in NAPSI scores (43% at week 16, 86% at week 28, and 100% at week 40)	N/A
Vitiello et al. [67]	2013	13	Ustekinumab	—	90 mg (𝑛=5, patients weight > 100 kg), sc, at weeks 0, 4 and every 12 weeks thereafter or 45 mg in combination with MTX (𝑛=6) or CsA (𝑛=2)	38% reduction in NAPSI scores in monotherapy group, 27% reduction in MTX combination, complete resolution in CsA combination group, at week 12	N/A
Igarashi et al. [68]	2012	102	Ustekinumab	Placebo	45 or 90 mg, sc, at weeks 0, 4 and every 12 weeks through 72 weeks, placebo group with crossover to ustekinumab at week 12	Improvement in NAPSI scores: 57% in 45 mg group, 68% in 90 mg group at week 64	A2
Reich et al. [69]	2011	317	Briakinumab	MTX	Briakinumab 200 mg at weeks 0 and 4, 100 mg every 4 weeks through week 48, sc, MTX 5–25 mg/week for 51 weeks	NAPSI scores of the target fingernail significantly lower with the briakinumab group at weeks 24 and 52, as compared with the methotrexate group	N/A

𝑛: number of patients.
sc: subcutaneous.
iv: intravenous.
im: intramuscular.
N/A: not applicable.
NAPSI: nail psoriasis severity index.
MTX: methotrexate.
CsA: cyclosporine.
LoE: level of evidence (A2: randomized, double-blind, controlled trial of good quality, B: randomized controlled trial of poor quality).