Brodalumab provides rapid and significant improvement in nail psoriasis, according to results from an open-label, unblinded study accepted for publication in the Journal of the European Academy of Dermatology and Venereology.
Dermatology patients at the Andreas Sygos Hospital in Athens, Greece with confirmed severe plaque-type psoriasis and evident psoriatic nail disease were given subcutaneous injections of brodalumab 210 mg at baseline, weeks 1, 2, 3, and every 2 weeks thereafter. Patient nails were assessed at baseline and weeks 12 and 24. The study’s primary objective was to evaluate brodalumab’s efficacy in nail psoriasis as assessed by the Nail Psoriasis Severity Index (NAPSI) and the Dermatology Life Quality Index (DLQI).
There were 30 patients enrolled in the study. The mean NAPSI score for fingernails at baseline was 19.6 (standard deviation [SD], 9.3). At week 12 it was 9.6 (SD, 5.3; P <.001) and at week 24 it was 2.63 (SD, 2.3; P <.001). The mean NAPSI score for toenails was 24.9 (SD, 13.6) at baseline. At week 12 it was 16.1 (SD, 9.7; P <.001) and at week 24 it was 7.2 (SD, 6.1; P <.001). The mean DLQI score for finger and toenails was 22.8 (SD, 4.4) at baseline and 3.7 (SD, 2.2; P <.001) at week 24. There was improvement in 57% (n=17) of patients with a fingernail NAPSI score of 50 by week 12 and in 100% (n=30) of patients by week 24. There was improvement in 23% (n=7) patients with a toenail NAPSI score of 50 by week 12 and in 97% (n=29) patients by week 24. The only adverse events recorded were headache in 2 patients and diarrhea in 1 patient, all of which resolved spontaneously in a few days.
Study limitations included the single-center design and the absence of a control group.
Study authors commented that their results “support the need of prolonged therapy before evaluating the full efficacy of biologics in psoriasis of this specific body site,” in addition to demonstrating brodalumab’s rapid onset, high efficacy, and safety for nail psoriasis.
Gregoriou S, Tsiogka A, Tsimbidakis A, Nicolaidou E, Knotochristopoulos G, Rigopoulos D. Treatment of nail psoriasis with brodalumab: An open label unblinded study. J Eur Acad Dermatol Venereol. Published online December 2, 2020. doi: 10.1111/jdv.17055