Bimekizumab Better Improves Nail Psoriasis vs Secukinumab

A higher proportion of patients with moderate to severe plaque psoriasis treated with bimekizumab experienced complete nail clearance at 48 weeks compared with those who received secukinumab, according to study results presented at the American Academy of Dermatology (AAD) Association 2023 conference, held from March 17 to 21, 2023, in New Orleans, Louisiana.

According to the study authors, “Psoriatic lesions in highly visible areas, including the nails, disproportionately affect patients’ health‑related quality of life.”

Researchers compared the efficacy of bimekizumab and secukinumab through 48 weeks for treatment of nail psoriasis, including complete nail clearance, in patients with moderate to severe plaque psoriasis who had moderate to severe nail involvement. They used modified Nail Psoriasis Severity Index (mNAPSI) total scores and subscore complete clearance rates among patients with a baseline mNAPSI score greater than 10 at weeks 16 and 48.

The study consisted of 116 patients who received bimekizumab (mean age, 45.7±14.0 years; 81% men) and 99 treated with secukinumab (mean age, 43.9±12.8 years; 82% men).

Among the cohort, 37.1% patients in the bimekizumab group and 40.4% in the secukinumab group achieved an mNAPSI score of 2 or less at week 16, and 75.0% in the bimekizumab group and 59.6% in the secukinumab group achieved an mNAPSI score of 2 or less at week 48. For weeks 16 to 48, response rates for mNAPSI scores of 0 (clear) increased from 26.7% to 70.7% in the bimekizumab group and from 33.3% to 53.5% in the secukinumab group.

A total of 103 patients who were treated with bimekizumab and 84 who were treated with secukinumab had baseline mNAPSI scores greater than 10 and baseline onycholysis/oil drop dyschromia scores greater than 0. At week 16, 63.1% of the bimekizumab group and 64.3% of the secukinumab group had an onycholysis/oil drop dyschromia score of 0 (clear), and 83.5% of the bimekizumab group and 66.7% of the secukinumab group had an onycholysis/oil drop dyschromia score of 0 at week 48.

Among the participants, 101 who received bimekizumab and 86 who received secukinumab had baseline mNAPSI scores greater than 10 and baseline nail pitting greater than 0. At week 16, 36.6% of the bimekizumab group and 41.9% of the secukinumab group had nail pitting of 0 (clear). A total of 78.2% of the bimekizumab group and 59.3% of the secukinumab group achieved nail pitting of 0 at week 48.

A total of 69 patients who were treated with bimekizumab and 56 who were treated with secukinumab had baseline mNAPSI scores greater than 10 and baseline nail plate crumbling greater than 0. At week 16, 65.2% of the bimekizumab group and 69.6% of the secukinumab group achieved nail plate crumbling of 0 (clear). A total of 85.5% of the bimekizumab group and 75.0% of the secukinumab group had nail plate crumbling of 0 at week 48.

In addition, 59 participants who received bimekizumab and 58 participants who received secukinumab had baseline mNAPSI scores greater than 10 and baseline leukonychia levels greater than 0. At week 16, 69.5% of the bimekizumab group and 70.7% of the secukinumab group had a leukonychia level of 0 (clear). A total of 79.7% of the bimekizumab group and 69.0% of the secukinumab group had a leukonychia level of 0 at week 48.

Participants treated with bimekizumab also had higher rates of complete clearance at week 48 vs those who received secukinumab regarding nail bed hyperkeratosis (83.6% vs 80.4%) and splinter hemorrhages (68.1% vs 63.6%).

Those who received secukinumab had a slightly higher rate of complete clearance of red spots in the lunula at week 48 compared with those who received bimekizumab (81.8% vs 81.0%).

Study authors conclude, “From weeks 16-48, [bimekizumab]-treated patients showed numerically greater improvements in nail psoriasis than [secukinumab]‑treated patients, including complete nail clearance.”

Disclosure: This study was funded by UCB Pharma. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.