Targeting nail psoriasis: IL-17A inhibitors demonstrate site-specific superiority over IL-23 inhibitor in a 24-week dermoscopy-guided real-world cohort
ObjectiveTo compare the real-world clinical efficacy and safety of interleukin (IL)-17A inhibitors (secukinumab [SEC] and ixekizumab [IXE]) versus the IL-23 inhibitor guselkumab (GUS) in patients with nail psoriasis, with a focus on site-specific biologic therapeutic responses (nail matrix vs. nail...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1573715/full |
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| author | Xiamei Yan Xiamei Yan Minglan Shi Bin Wang Lihua Zeng Huiwei Wang Jialiang Shi Yaqian Cui Suchun Hou |
| author_facet | Xiamei Yan Xiamei Yan Minglan Shi Bin Wang Lihua Zeng Huiwei Wang Jialiang Shi Yaqian Cui Suchun Hou |
| author_sort | Xiamei Yan |
| collection | DOAJ |
| description | ObjectiveTo compare the real-world clinical efficacy and safety of interleukin (IL)-17A inhibitors (secukinumab [SEC] and ixekizumab [IXE]) versus the IL-23 inhibitor guselkumab (GUS) in patients with nail psoriasis, with a focus on site-specific biologic therapeutic responses (nail matrix vs. nail bed) in a 24-week prospective observational cohort.MethodsThis cohort enrolled 65 adult patients with plaque psoriasis and dermoscopy-confirmed nail involvement, stratified into three treatment groups: SEC (n=25), IXE (n=20), and GUS (n=20). Outcome assessments at baseline and week 24 included: Nail Psoriasis Severity Index (NAPSI) with domain-specific scoring (matrix/bed) by dermoscopic evaluation using a 10× polarized handheld device; Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA); Dermatology Life Quality Index (DLQI). Safety was monitored through treatment-emergent adverse events (TEAEs).Results(1) By week 24, PASI, BSA, DLQI and NAPSI scores had significantly decreased from baseline in all groups (P<0.001). (2) By week 24: SEC, IXE, and GUS groups saw nail matrix NAPSI score improvements of 65.9%, 60.5%, and 51.5%, with 68%, 55%, and 30% achieving NAPSI 60; Nail bed NAPSI score improvements were 58.8%, 68.6%, and 65.8%, with 28%, 65%, and 40% achieving NAPSI 60; Total NAPSI score improvements were 62.7%, 64.6%, and 53.7%, with 44%, 70%, and 30% achieving NAPSI 60. (3) All patients in the SEC and IXE groups achieved PASI 75, compared to 85% in the GUS group. SEC showed PASI 90 and PASI 100 response rates of 80% and 36%, while IXE of 60% and 30%. (4) TEAEs were mild, including: injection site reactions: 15% (IXE group); eczematous rashes: 8% (SEC group). No TEAEs were reported in the GUS group, and no serious adverse events occurred in any group.ConclusionIL-17A inhibitors and the IL-23 inhibitor demonstrated significant efficacy in improving both nail and skin lesions in psoriasis. Notably, IL-17A inhibitors exhibited superior overall efficacy compared to IL-23 inhibitor. Specifically, SEC excelled in improving dermoscopic nail matrix changes, whereas IXE was more potent for nail bed pathology. All groups significantly improved patients’ life quality and exhibited good safety profiles. |
| format | Article |
| id | doaj-art-293e0e24e8ee4b04827f53f75f4e7c9c |
| institution | OA Journals |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Immunology |
| spelling | doaj-art-293e0e24e8ee4b04827f53f75f4e7c9c2025-08-20T02:16:21ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-04-011610.3389/fimmu.2025.15737151573715Targeting nail psoriasis: IL-17A inhibitors demonstrate site-specific superiority over IL-23 inhibitor in a 24-week dermoscopy-guided real-world cohortXiamei Yan0Xiamei Yan1Minglan Shi2Bin Wang3Lihua Zeng4Huiwei Wang5Jialiang Shi6Yaqian Cui7Suchun Hou8Department of Dermatology, Nanshan Maternity and Child Health Care Hospital, Shenzhen, ChinaDepartment of Dermatology, Shenzhen Hospital, The University of Hong Kong, Shenzhen, ChinaDepartment of Dermatology, Shenzhen University General Hospital, Shenzhen, ChinaDepartment of Dermatology, Shenzhen University General Hospital, Shenzhen, ChinaDepartment of Dermatology, Shenzhen Hospital, The University of Hong Kong, Shenzhen, ChinaDepartment of Dermatology, Shenzhen Hospital, The University of Hong Kong, Shenzhen, ChinaDepartment of Dermatology, Shenzhen University General Hospital, Shenzhen, ChinaDepartment of Dermatology, Shenzhen Longhua People’s Hospital, Shenzhen, ChinaDepartment of Dermatology, Shenzhen University General Hospital, Shenzhen, ChinaObjectiveTo compare the real-world clinical efficacy and safety of interleukin (IL)-17A inhibitors (secukinumab [SEC] and ixekizumab [IXE]) versus the IL-23 inhibitor guselkumab (GUS) in patients with nail psoriasis, with a focus on site-specific biologic therapeutic responses (nail matrix vs. nail bed) in a 24-week prospective observational cohort.MethodsThis cohort enrolled 65 adult patients with plaque psoriasis and dermoscopy-confirmed nail involvement, stratified into three treatment groups: SEC (n=25), IXE (n=20), and GUS (n=20). Outcome assessments at baseline and week 24 included: Nail Psoriasis Severity Index (NAPSI) with domain-specific scoring (matrix/bed) by dermoscopic evaluation using a 10× polarized handheld device; Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA); Dermatology Life Quality Index (DLQI). Safety was monitored through treatment-emergent adverse events (TEAEs).Results(1) By week 24, PASI, BSA, DLQI and NAPSI scores had significantly decreased from baseline in all groups (P<0.001). (2) By week 24: SEC, IXE, and GUS groups saw nail matrix NAPSI score improvements of 65.9%, 60.5%, and 51.5%, with 68%, 55%, and 30% achieving NAPSI 60; Nail bed NAPSI score improvements were 58.8%, 68.6%, and 65.8%, with 28%, 65%, and 40% achieving NAPSI 60; Total NAPSI score improvements were 62.7%, 64.6%, and 53.7%, with 44%, 70%, and 30% achieving NAPSI 60. (3) All patients in the SEC and IXE groups achieved PASI 75, compared to 85% in the GUS group. SEC showed PASI 90 and PASI 100 response rates of 80% and 36%, while IXE of 60% and 30%. (4) TEAEs were mild, including: injection site reactions: 15% (IXE group); eczematous rashes: 8% (SEC group). No TEAEs were reported in the GUS group, and no serious adverse events occurred in any group.ConclusionIL-17A inhibitors and the IL-23 inhibitor demonstrated significant efficacy in improving both nail and skin lesions in psoriasis. Notably, IL-17A inhibitors exhibited superior overall efficacy compared to IL-23 inhibitor. Specifically, SEC excelled in improving dermoscopic nail matrix changes, whereas IXE was more potent for nail bed pathology. All groups significantly improved patients’ life quality and exhibited good safety profiles.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1573715/fullnail psoriasisdermoscopyIL-17A inhibitorsIL-23 inhibitorreal-world cohortNAPSI |
| spellingShingle | Xiamei Yan Xiamei Yan Minglan Shi Bin Wang Lihua Zeng Huiwei Wang Jialiang Shi Yaqian Cui Suchun Hou Targeting nail psoriasis: IL-17A inhibitors demonstrate site-specific superiority over IL-23 inhibitor in a 24-week dermoscopy-guided real-world cohort Frontiers in Immunology nail psoriasis dermoscopy IL-17A inhibitors IL-23 inhibitor real-world cohort NAPSI |
| title | Targeting nail psoriasis: IL-17A inhibitors demonstrate site-specific superiority over IL-23 inhibitor in a 24-week dermoscopy-guided real-world cohort |
| title_full | Targeting nail psoriasis: IL-17A inhibitors demonstrate site-specific superiority over IL-23 inhibitor in a 24-week dermoscopy-guided real-world cohort |
| title_fullStr | Targeting nail psoriasis: IL-17A inhibitors demonstrate site-specific superiority over IL-23 inhibitor in a 24-week dermoscopy-guided real-world cohort |
| title_full_unstemmed | Targeting nail psoriasis: IL-17A inhibitors demonstrate site-specific superiority over IL-23 inhibitor in a 24-week dermoscopy-guided real-world cohort |
| title_short | Targeting nail psoriasis: IL-17A inhibitors demonstrate site-specific superiority over IL-23 inhibitor in a 24-week dermoscopy-guided real-world cohort |
| title_sort | targeting nail psoriasis il 17a inhibitors demonstrate site specific superiority over il 23 inhibitor in a 24 week dermoscopy guided real world cohort |
| topic | nail psoriasis dermoscopy IL-17A inhibitors IL-23 inhibitor real-world cohort NAPSI |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1573715/full |
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