Ixekizumab Associated With Greater Resolution of Nail Psoriasis vs Guselkumab

An example of plaque psoriasis on a patient's back
An example of plaque psoriasis on a patient’s back
Skin and nail clearance and patient-reported outcomes for ixekizumab vs guselkumab, up to week 24, were compared.

Although treatment with ixekizumab generated similar levels of skin clearance as treatment with guselkumab in patients with moderate to severe plaque psoriasis, ixekizumab was associated with greater resolution of nail psoriasis after 24 weeks of therapy, according to results from the IXORA-R trial published in the British Journal of Dermatology.

The IXORA-R trial enrolled adults with moderate to severe chronic plaque psoriasis, a Psoriasis Area and Severity Index (PASI) of 12 or greater, and a body surface area involvement of 10% or more at both screening and baseline. Patients were subsequently randomly assigned to subcutaneous injections of either ixekizumab (n=465) or guselkumab (n=459). Ixekizumab was administered at 80 mg every 4 weeks from weeks 12 through 24, whereas guselkumab was administered at a dose of 100 mg at weeks 12 and 20. Patients assigned to guselkumab also received 1 placebo injection at week 16 to maintain blinding.

A significantly greater percentage of patients in the ixekizumab arm achieved PASI 100 by week 2 and through week 16 (P <.01). Treatment with ixekizumab was deemed noninferior to guselkumab at week 24 in terms of the percentage of patients who achieved PASI 100 (50% vs 52%, respectively; difference, -2·3%; P =.414).

In contrast, a significantly greater percentage of patients treated with ixekizumab had completely clear nails by week 24 compared with those assigned to guselkumab (52% vs 31%, respectively; P =.007). At week 24, approximately 75% of 83 patients assigned to ixekizumab and 54% of 59 patients assigned to guselkumab with moderate to severe nail psoriasis reached clear nails or minimal nail psoriasis (P =.020) or complete clearance of nail psoriasis. In sddition, a higher percentage of patients treated with ixekizumab achieved complete clearance of nail psoriasis by week 24 (52% vs 31%; P =.007).

Treatment with ixekizumab was also associated with a greater cumulative benefit, including a greater number of days of PASI 90 (95.2 vs 78.6 days; p<0.001) and 100 (55.6 vs 42.2 days; P <.001), more days with Dermatology Life Quality Index of 0 or 1 (84.9 vs 77.4 days; P =.026), and more days without itch (51.2 vs 41.5 days; P =.002). The frequency of serious adverse events was 3% for each group, and no new safety signals were reported.

Limitations of this trial included its relatively short duration as well as the recruitment of only patients from the United States and Canada, which the investigators suggest may limit the generalization of the results.

The researchers wrote that “because the long-term profile displayed by ixekizumab is quite consistent across” a “phase 3 program, it is likely that ixekizumab and guselkumab have similar long-term efficacy in the treatment of psoriasis.”

Disclosure: This clinical trial was supported by Eli Lilly and Company. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Blauvelt A, Leonardi C, Elewski B, et al. A head-to-head comparison of ixekizumab versus guselkumab in patients with moderate-to-severe plaque psoriasis: 24-week efficacy and safety results from a randomised, double-blinded trial. Published online September 2, 2020. Br J Dermatol. doi:10.1111/bjd.19509