Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Dermatology, University Hospital Lausanne CHUV, Lausanne, Switzerland.
J Dermatolog Treat. 2022 May;33(3):1652-1660. doi: 10.1080/09546634.2021.1892024. Epub 2021 Mar 1.
Nail psoriasis (NP) is common and of high importance in patients with psoriasis. Complete resolution of NP at week 24‒26 is an unambiguous nail outcome accessible for indirect treatment comparison of biologics.
To evaluate the comparative efficacy of approved biologics in achieving complete resolution of NP at week 24‒26.
A network meta-analysis (NMA) was conducted to indirectly compare the efficacy of six biologics in achieving complete resolution of NP at week 24‒26 in patients with moderate-to-severe psoriasis and concomitant NP. Complete resolution of NP was defined as a score of zero on the Nail Psoriasis Severity Index (NAPSI), modified NAPSI (mNAPSI) or Physician's Global Assessment of Fingernails (PGA-F).
The probability of achieving complete resolution of NP was highest for ixekizumab (46.5%; 95% credibility interval [CrI] 35.1‒58.0; Surface Under the Cumulative RAnking curve [SUCRA] 97%), followed by brodalumab (37.0%; 17.0‒61.0; 79%), adalimumab (28.3%; 24.4‒32.4; 62%), guselkumab (27.7%; 21.1‒35.1; 58%), ustekinumab (20.8%; 10.2‒35.2; 37%), and infliximab (0.8%; 0.0‒8.9; 17%).
In patients with moderate-to-severe psoriasis and concomitant NP, ixekizumab has the greatest likelihood among approved biologics of achieving complete resolution of NP at week 24‒26. Findings should be interpreted carefully because of inherent study limitations.
甲银屑病（NP）在银屑病患者中较为常见且十分重要。24-26 周时 NP 完全缓解是可用于生物制剂间接治疗比较的明确指甲结局。
评估已获批生物制剂在 24-26 周时达到 NP 完全缓解的疗效比较。
采用网络荟萃分析（NMA），间接比较中重度银屑病伴 NP 的患者中，6 种生物制剂在 24-26 周时达到 NP 完全缓解的疗效。NP 完全缓解定义为指甲银屑病严重程度指数（NAPSI）、改良 NAPSI（mNAPSI）或医师整体评估指甲（PGA-F）评分为 0。
ixekizumab 达到 NP 完全缓解的概率最高（46.5%；95%可信区间 [CrI]：35.1-58.0；表面排序累积曲线下面积 [SUCRA]：97%），其次是 brodalumab（37.0%；17.0-61.0；79%）、阿达木单抗（28.3%；24.4-32.4；62%）、古塞库单抗（27.7%；21.1-35.1；58%）、乌司奴单抗（20.8%；10.2-35.2；37%）和英夫利昔单抗（0.8%；0.0-8.9；17%）。
在中重度银屑病伴 NP 的患者中，与已获批的生物制剂相比，ixekizumab 最有可能在 24-26 周时达到 NP 完全缓解。由于存在固有研究局限性，应谨慎解释研究结果。
