Ixekizumab resolves nail psoriasis better than adalimumab in PsA

Ixekizumab, a humanised monoclonal antibody that targets IL-17A, had several advantages over adalimumab in participants with psoriatic arthritis (PsA). In a post-hoc analysis, ixekizumab was more effective in resolving distal interphalangeal (DIP) joint tenderness, joint swelling, and adjacent nail psoriasis among the finger units.

Nail psoriasis tends to be more common and is usually more severe in patients with PsA and DIP joint disease. It has been reported in about three-quarters of PsA patients. In the SPIRIT-H2H study (NCT03151551), ixekizumab was associated with significantly greater improvements in nail psoriasis than adalimumab in PsA adult participants [1]. A post-hoc analysis aimed to evaluate the effectiveness of both treatments in improving DIP tenderness and nail psoriasis [2]. The analysis included a subgroup of 354 participants from SPIRIT-H2H with nail psoriasis and adjacent joint tenderness and/or swelling in at least 1 digit. Participants had been treated with ixekizumab (n=186) or adalimumab (n=168). Nail psoriasis was measured using the Nail Psoriasis Severity Index (NAPSI) in the fingers only; joint involvement was measured by tender and swollen joint count scores (TJC68/SJC66, respectively). A finger unit was defined by the nail and adjacent joint of an individual digit. Participants were evaluated in weeks 0, 12, 16, 24, 32, 40, and 52. The study results were presented in a poster by Prof. Dennis McGonagle (University of Leeds, United Kingdom).

At baseline, the number of affected finger units was 639 in the ixekizumab group and 670 in the adalimumab group. The complete resolution of DIP joint tenderness, DIP joint swelling, and adjacent nail psoriasis at the finger unit was achieved in a significantly higher percentage of participants in the ixekizumab group versus the adalimumab group at all time points from week 12 to week 52 (65% vs 58% at week 52). Resolution of DIP joint tenderness and/or swelling was significantly higher in the ixekizumab group at most time points (88% vs 78% at week 52). The difference in treatment effect between ixekizumab and adalimumab was less pronounced in the resolution of DIP joint swelling (95% and 90% at week 52). The resolution of nail psoriasis at the finger unit level was significantly higher with ixekizumab compared with adalimumab at all time points from week 12 to week 52 (85% and 80% at week 52).

1. Smolen JS, et al. Ann Rheum Dis. 2020;79:1310-9.
2. McGonagle D, et al. Ixekizumab significantly improves nail disease and adjacent joint tenderness and swelling in psoriatic arthritis. P2231, ACR Convergence 2023, 10–15 November, San Diego, USA.

Medical writing support was provided by Michiel Tent.
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Posted on 1 December, 20231 December, 2023