Assessing the Impact of Efalizumab on Nail, Scalp and Palmoplantar Psoriasis and on Quality of Life: Results from a Multicentre, Open-label, Phase IIIb/IV Trial

Efficacy and Safety of Nail Psoriasis Targeted Therapies: A Systematic Review

INTRODUCTION

Nail changes are frequent clinical findings in patients with cutaneous psoriasis and psoriatic arthritis, often causing significant impairments in quality of life. Numerous targeted therapies have been previously studied for treatment of nail psoriasis, however, newer agents have not been captured in prior systematic reviews. With over 25 new studies published since 2020, the landscape of nail psoriasis systemic treatments is rapidly evolving, warranting analysis of recently approved therapies.

METHODS

An updated systematic review of all PubMed and OVID database studies assessing efficacy and safety of targeted therapies for nail psoriasis was performed, with the goal of incorporating clinical data of recent trials and newer agents, namely brodalumab, risankizumab, and tildrakizumab. Eligibility criteria included clinical human studies reporting at least one of the nail psoriasis clinical appearance outcomes (Nail Psoriasis Severity Index, modified Nail Psoriasis Severity Index).

RESULTS

A total of 68 studies on 15 nail psoriasis targeted therapeutic agents were included. Biological agents and small molecule inhibitors included TNF-alpha inhibitors (adalimumab, infliximab, etanercept, certolizumab, golimumab), IL-17 inhibitors (ixekizumab, brodalumab, secukinumab), IL-12/23 inhibitors (ustekinumab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), PDE-4 inhibitors (apremilast), and JAK inhibitors (tofacitinib). These agents all demonstrated statistically significant improvements in nail outcome scores, compared with placebo or with baseline values, at weeks 10-16 and weeks 20-26, with some studies assessing efficacy up to week 60. Safety data for these agents were acceptable and consistent with known safety profiles within these timepoints, with nasopharyngitis, upper respiratory tract infections, injection site reactions, headache, and diarrhea being the most reported adverse events. Specifically, the newer agents, brodalumab, risankizumab, and tildrakizumab, showed promising outcomes for treatment of nail psoriasis on the basis of current data.

CONCLUSION

Numerous targeted therapies have shown significant efficacy in improving nail findings in patients with psoriasis and psoriatic arthritis. Data from head-to-head trials have shown greater efficacy of ixekizumab over adalimumab and ustekinumab, as well as brodalumab over ustekinumab, while prior meta-analyses have demonstrated superiority of ixekizumab and tofacitinib to other included agents at various assessed timepoints. Further studies on the long-term efficacy and safety of these agents, as well as randomized controlled trials involving comparison with placebo arms, are needed to fully analyze differences in efficacy of newer agents compared with previously established therapies.

Psoriasis and psoriatic arthritis educational initiatives: an update from the 2013 GRAPPA Annual Meeting

At the 2013 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members were updated on educational areas in psoriasis and psoriatic arthritis (PsA). Discussions included (1) the psoriasis and PsA GRAPPA video project, comprising a set of educational online videos that provide standardized psoriatic disease endpoint training to clinicians and researchers; (2) the GRAPPA Educational Outreach Project, focused on cross-disciplinary education for rheumatologists and dermatologists and including several collaborations to expand educational sessions globally; (3) the Dermatology and Rheumatology Trainee Educational Initiative, that provides psoriatic disease education to medical students, residents, and fellows training in dermatology and/or rheumatology; and (4) the GRAPPA Educational Slide Library, developed as a resource for GRAPPA members for their own educational presentations.

Psoriasis and psoriatic arthritis video project: an update from the 2012 GRAPPA annual meeting

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has developed online videos intended to provide training on the most commonly used physical examination measures for psoriasis and psoriatic arthritis (PsA). At the 2012 GRAPPA annual meeting, attendees were updated on the development, availability, use, and validation of these video modules. To date, 1300 users from 45 different countries have used the Psoriasis Area and Severity Index (PASI) module at least once. Results were presented from a recently completed study of pre- and post-video scoring of the PASI by experienced and naive physicians and patient assessors. Future modifications of the video collection were also discussed.

Psoriasis and psoriatic arthritis video project: an update from the GRAPPA 2011 annual meeting

Numerous physical examination instruments are used to assess and measure severity of psoriasis and psoriatic arthritis (PsA) in practice and in clinical trials. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has developed several online training modules used by GRAPPA members and investigators participating in psoriasis and PsA research. At the 2011 GRAPPA meeting, attendees were updated on the ongoing development of the training modules. Several Internet-based multimedia presentations for psoriasis and PsA assessments have been completed. Available psoriasis modules include the Psoriasis Area and Severity Index (PASI) and Body Surface Area, one 5-point and two 6-point Physician Global Assessments, the original and modified Nail Psoriasis Severity Index, the Palmar-Plantar Pustular Psoriasis Area and Severity Index, the Psoriasis Scalp Severity Index, and the Total Plaque Severity Score. Rheumatology modules that demonstrate evaluation of swollen and tender joints, enthesitis, and dactylitis are now available, and an axial disease evaluation module is near completion. Each video includes the background and rationale for each measure, demonstration videos of select examinations, diagrams, and photographs to emphasize teaching points, and for most dermatology modules, an optional test to assess competence. Preliminary data generated by a pilot study of pre- and post-education PASI scoring by experienced and naive physicians and patient assessors were presented, revealing improved accuracy of scoring after viewing the PASI video. Attendees agreed that additional patient examples with more diverse skin types and psoriasis phenotypes, translation to languages other than English, and further validation studies are needed.

Psoriasis and Psoriatic Arthritis Video Project: An Update from the 2010 GRAPPA Annual Meeting

Changes in severity of psoriasis and psoriatic arthritis (PsA) are assessed in clinical trials by a variety of physical examination instruments. At the 2010 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members were updated on the development and availability of modules that teach these instruments. Web-based interactive multimedia presentations for psoriasis assessments have been completed, including modules for Psoriasis Area and Severity Index and Body Surface Area, 5-point and 6-point Physician Global Assessment, the original and modified Nail Psoriasis Severity Index, the Palmar-Plantar Pustular Psoriasis Area and Severity Index, and the Psoriasis Scalp Severity Index. Rheumatology modules will include assessment of tender and swollen joints, and evaluations of enthesitis, dactylitis, and axial disease. Each module will include the background and rationale for each tool, demonstration video of each examination, diagrams and photographs to emphasize teaching points, and an optional examination at the end. The rheumatology modules have been recorded but were not yet available for review at the meeting. The dermatology modules are currently in use by pharmaceutical and biotechnology companies engaged in research on treatments for psoriasis and PsA. The next phase of this project includes analysis of interobserver reliability, translation into languages other than English for international users, and other proposed studies.

Psoriasis and Psoriatic Arthritis Video Project 2010: A Report from the GRAPPA Annual Meeting

Investigators use several physical examination measures to assess clinical features and severity of psoriasis and psoriatic arthritis (PsA) in clinical trials, clinical registries, and clinical practice; however, no relevant training modules are widely available to teach and standardize the performance of these measures. At a GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) meeting adjacent to the 2009 International Federation of Psoriasis Associations in Stockholm, members were updated on the development status of online training videos of psoriasis and PsA examination measures. Dermatology assessment modules include the Psoriasis Area and Severity Index, the Static Physician Global Assessment, body surface area, the original and modified Nail Psoriasis Severity Index, the Palmar-Plantar Pustular Psoriasis Area and Severity Index, and the Psoriasis Scalp Severity Index. Rheumatology modules include assessment of tender and swollen joint counts used in the American College of Rheumatology criteria, Disease Activity Score, and other composite arthritis scores; enthesitis assessment used in various enthesitis scoring systems; dactylitis; and spine disease. Each module will include background information for each measure, diagrams and photographs to emphasize teaching points, demonstration video of examination where applicable, and an optional examination at the end. Future plans include evaluating the modules for their influence on interrater and intrarater reliability and development of additional modules.