USA: In five head-to-head trials, treatment with ixekizumab in psoriasis patients was associated with higher rates of simultaneous complete skin and nail clearance compared to adalimumab, ustekinumab, guselkumab, and etanercept.
The results from a post hoc analysis of 5 head-to-head trials, published in the journal Dermatology and Therapy, strengthen ixekizumab's ability to achieve high levels of efficacy in multiple domains of psoriatic disease.

In patients with psoriasis, the lifetime incidence of nail psoriasis is 80–90%, with 23–27% of patients having nail psoriasis at any given time. It is even more prevalent in patients with comorbid psoriatic arthritis. The resolution of nail psoriasis should ideally be included in complete psoriasis clearance, an achievable therapeutic goal. Comparisons of available treatments can help guide dermatologists to prescribe the most appropriate treatment
Boni E. Elewski, University of Alabama, Birmingham, AL, USA, and colleagues aimed to assess simultaneous skin and nail clearance in patients with psoriasis across five head-to-head trials comparing ixekizumab with other biologics.
For this purpose, the researchers assessed data in patients with moderate-to-severe psoriasis (with or without psoriatic arthritis) with nail psoriasis at baseline from the IXORA-R, IXORA-S, UNCOVER-2, UNCOVER-3, and SPIRIT-H2H trials. Ixekizumab patients received IXEQ2W to week 12 and IXEQ4W beyond week 12.
Complete skin clearance was depicted in PASI 100 and PGA-F 0 (IXORA-R) or NAPSI 0 (all other trials) depicted complete nail clearance. Cochran-Mantel-Haenszel test was used to evaluate treatment comparisons.
Salient findings of the study include:
Ixekizumab achieved significantly greater simultaneous skin and nail complete clearance than etanercept (UNCOVER-2 and UNCOVER-3) at week 12, demonstrating an efficacious and rapid response.
Across all five head-to-head trials, ixekizumab achieved a high rate of simultaneous skin and nail clearance (range: 28.6–45.9% of patients) by week 24 that was maintained up to week 52 (range: 40.5–51.4% of patients).
Ixekizumab achieved numerically greater simultaneous complete clearance than guselkumab at week 24, but statistically significant greater simultaneous clearance compared to ustekinumab and adalimumab at week 24 and week 52.
"Across five head-to-head trials, ixekizumab-treated patients had higher rates of simultaneous complete skin and nail clearance compared to etanercept, guselkumab, ustekinumab, and adalimumab," the authors wrote. "This reinforces ixekizumab's ability to achieve high levels of efficacy in multiple domains of psoriatic disease."
Reference:
Elewski, B.E., Blauvelt, A., Gallo, G. et al. Simultaneous Nail and Skin Clearance in Ixekizumab Head-to-Head Trials for Moderate-to-Severe Psoriasis and Psoriatic Arthritis. Dermatol Ther (Heidelb) (2022). https://doi.org/10.1007/s13555-022-00704-2