Nail psoriasis dynamics during biologic treatment and withdrawal in patients with psoriasis who may be at high risk of developing psoriatic arthritis: a post hoc analysis of the VOYAGE 2 randomized trial

Arthritis Research & Therapy

Research

Alexander Egeberg¹  William Tillett²  Enikö Sonkoly³  Jozefien Buyze⁴  Anna Tjärnlund⁵  Sven Wegner⁶  Patricia Gorecki⁷  Dennis McGonagle⁸ 

[1] Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark;Department of Clinical Medical, University of Copenhagen, Copenhagen, Denmark;Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Combe Park, BA1 3NG, Bath, UK;Department of Life Sciences, University of Bath, Bath, UK;Dermatology and Venereology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden;Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden;Janssen Pharmaceutica NV, Beerse, Belgium;Janssen-Cilag AB, Solna, Sweden;Janssen-Cilag GmbH, Neuss, Germany;Janssen-Cilag Ltd, High Wycombe, UK;Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK;National Institute for Health and Care Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK;

关键词: Nail psoriasis;    Guselkumab;    Adalimumab;    IL-23 inhibition;    Withdrawal;   

DOI  :  10.1186/s13075-023-03138-z

 received in 2023-03-23, accepted in 2023-08-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundNail psoriasis is a common, physiologically, and psychologically disruptive, and yet often under-treated manifestation of psoriasis. The objectives of this analysis were to investigate the trajectory of nail psoriasis, a risk factor for psoriatic arthritis (PsA), with guselkumab vs adalimumab treatment followed by withdrawal, and determine characteristics associated with nail response in patients treated with guselkumab.MethodsThis post hoc analysis of the phase III trial VOYAGE 2 included patients with moderate-to-severe plaque psoriasis and baseline nail involvement. Nail Psoriasis Severity Index (NAPSI) and Psoriasis Area and Severity Index (PASI) were analyzed through week 48 in patients randomized to guselkumab or adalimumab. Multiple logistic regression analyzed factors associated with NAPSI 0/1 at week 24/week 48 following guselkumab treatment. In a separate analysis, patients were stratified by prior biologic experience.ResultsOverall, 272 vs 132 patients receiving guselkumab vs adalimumab had nail psoriasis at baseline. Lower baseline NAPSI and week 16 PASI were associated with achieving NAPSI 0/1 at week 24 (NAPSI, odds ratio 0.685 [95% confidence interval: 0.586, 0.802]; week 16 PASI, 0.469 [0.281, 0.782]) and week 48 (NAPSI, 0.784 [0.674, 0.914]; week 16 PASI, 0.557 [0.331, 0.937]) with guselkumab. Previous biologic experience did not impact NAPSI response. Following treatment withdrawal at week 28, mean NAPSI was maintained in the guselkumab arm (week 24 1.7, week 48 1.9) and increased slightly in the adalimumab arm (week 24 1.4, week 48 2.3). Mean PASI increased across both treatment arms.ConclusionsHigher skin efficacy at week 16 was associated with better nail responses during guselkumab treatment. Nail psoriasis improvements reflected skin improvements. Following guselkumab withdrawal, nail response was maintained longer than skin response. Future studies should investigate whether such improvements in nail response reduce patients’ risk of later PsA development.Trial registrationClinicalTrials.gov, NCT02207244. Registered July 31, 2014.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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