Treatment of nail psoriasis with tumor necrosis factor-alpha blocker agents: An open-label, unblinded, comparative study

In this study, weaimed to investigate comparatively how nail psoriasis respondsto treatment with tumor necrosis factor (TNF)-a antagonistagents. A total of 28 patients were enrolled into the study withmoderate to severe nail psoriasis, who had failed to respondto, were contraindicated for, or were intolerant of other sys-temic therapies. Three patients had psoriatic nails without skinlesions who were diagnosed with peculiar clinical features. Thelocal ethics committee approved the study and writteninformed consent was obtained from all patients.Before treatment, complete blood count (CBC), routineblood tests, serological markers for hepatitis, anti-HIV anti-body, antinuclear antibody, chest radiography and purified pro-tein derivative test were checked. Routine blood tests, CBCand chest radiography were repeated every 3 months duringthe study period.Participants were randomized into three treatment groups.Patients in the etanercept group (n = 9) received 50-mg s.c.injections twice every week for the first 12 weeks, and onceevery week thereafter. Patients in the adalimumab group(n = 8) received an initial 80 mg s.c. injection, and 40 mg atweek 1, then 40 mg every other week thereafter. Patients inthe infliximab group (n = 11) received i.v. infusions (5 mg/kg) atweeks 0, 2 and 6 and every 8 weeks through to week 46.Patients were evaluated at 0, 12, 24, 36 and 48 weeks withNail Psoriasis Severity Index (NAPSI) and modified NAPSI(mNAPSI) scores.At the end of 48 weeks of treatment, NAPSI improvementswere 53.8%, 57.3% and 40.4%, and mNAPSI improvementswere 48.6%, 59.6% and 40.4% in adalimumab, etanercept andinfliximab treatment groups, respectively (Table 1). Each treat-ment group was found effective in comparison with baselineand there was no statistically significant difference betweenthe groups in terms of effectiveness. No significant side-effectswhich require cutting off the treatment were observed duringthe study, except for toxic hepatitis in one patient in the ada-limumab treatment group. Upon discontinuation of therapy,laboratory findings of this patient returned back to normalspontaneously.Kyriakou et al.