Baseline nail disease in patients with moderate to severe psoriasis and response to treatment with infliximab during 1 year

Phoebe Rich, Christopher E.M. Griffiths, Kristian Reich, Frank O. Nestle, Richard K. Scher, Shu Li, Stephen Xu, Ming Chun Hsu, Cynthia Guzzo

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Abstract

Background: Although nail psoriasis occurs frequently in patients with psoriatic skin lesions, effective treatments are limited. Objective: Occurrence of nail psoriasis by type and incidence of nail clearance using the Nail Psoriasis Severity Index were evaluated. Methods: This was a 50-week, phase III study in which 378 patients with moderate to severe psoriasis were randomized 4:1 to infliximab (5 mg/kg) or placebo at weeks 0, 2, 6, and every 8 weeks through week 46, with placebo crossover to infliximab at week 24. Results: Of the 373 evaluated patients, 305 (81.8%) had baseline nail psoriasis. The right thumbnail was most often the worst involved nail, and pitting and onycholysis were the most common lesions. Among patients with baseline nail psoriasis, 6.9%, 26.2%, and 44.7% in the infliximab group had nail disease clearance at weeks 10, 24, and 50, respectively, versus 5.1% in the placebo group at week 24 (P < .001). Mean percent improvements in Nail Psoriasis Severity Index score at weeks 10 and 24 were 26.8% and 57.2%, respectively, in the infliximab group versus -7.7% and -4.1%, respectively, in the placebo group (both P < .001). At week 24, mean percent improvements in nail matrix and nail bed features were 52.9% and 69.2%, respectively (vs -1.9% and 18.4% for placebo; P < .001). Limitations: The study did not evaluate nail response beyond 1 year. Conclusions: Patients with psoriasis receiving infliximab experienced marked and sustained nail improvement.

Original languageEnglish (US)
Pages (from-to)224-231
Number of pages8
JournalJournal of the American Academy of Dermatology
Volume58
Issue number2
DOIs
StatePublished - Feb 1 2008

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Nail Diseases
Nails
Psoriasis
Placebos
Therapeutics
Infliximab
Onycholysis

ASJC Scopus subject areas

  • Dermatology

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Baseline nail disease in patients with moderate to severe psoriasis and response to treatment with infliximab during 1 year. / Rich, Phoebe; Griffiths, Christopher E.M.; Reich, Kristian; Nestle, Frank O.; Scher, Richard K.; Li, Shu; Xu, Stephen; Hsu, Ming Chun; Guzzo, Cynthia.

In: Journal of the American Academy of Dermatology, Vol. 58, No. 2, 01.02.2008, p. 224-231.

Research output: Contribution to journalArticle

Rich, Phoebe ; Griffiths, Christopher E.M. ; Reich, Kristian ; Nestle, Frank O. ; Scher, Richard K. ; Li, Shu ; Xu, Stephen ; Hsu, Ming Chun ; Guzzo, Cynthia. / Baseline nail disease in patients with moderate to severe psoriasis and response to treatment with infliximab during 1 year. In: Journal of the American Academy of Dermatology. 2008 ; Vol. 58, No. 2. pp. 224-231.
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abstract = "Background: Although nail psoriasis occurs frequently in patients with psoriatic skin lesions, effective treatments are limited. Objective: Occurrence of nail psoriasis by type and incidence of nail clearance using the Nail Psoriasis Severity Index were evaluated. Methods: This was a 50-week, phase III study in which 378 patients with moderate to severe psoriasis were randomized 4:1 to infliximab (5 mg/kg) or placebo at weeks 0, 2, 6, and every 8 weeks through week 46, with placebo crossover to infliximab at week 24. Results: Of the 373 evaluated patients, 305 (81.8{\%}) had baseline nail psoriasis. The right thumbnail was most often the worst involved nail, and pitting and onycholysis were the most common lesions. Among patients with baseline nail psoriasis, 6.9{\%}, 26.2{\%}, and 44.7{\%} in the infliximab group had nail disease clearance at weeks 10, 24, and 50, respectively, versus 5.1{\%} in the placebo group at week 24 (P < .001). Mean percent improvements in Nail Psoriasis Severity Index score at weeks 10 and 24 were 26.8{\%} and 57.2{\%}, respectively, in the infliximab group versus -7.7{\%} and -4.1{\%}, respectively, in the placebo group (both P < .001). At week 24, mean percent improvements in nail matrix and nail bed features were 52.9{\%} and 69.2{\%}, respectively (vs -1.9{\%} and 18.4{\%} for placebo; P < .001). Limitations: The study did not evaluate nail response beyond 1 year. Conclusions: Patients with psoriasis receiving infliximab experienced marked and sustained nail improvement.",
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AB - Background: Although nail psoriasis occurs frequently in patients with psoriatic skin lesions, effective treatments are limited. Objective: Occurrence of nail psoriasis by type and incidence of nail clearance using the Nail Psoriasis Severity Index were evaluated. Methods: This was a 50-week, phase III study in which 378 patients with moderate to severe psoriasis were randomized 4:1 to infliximab (5 mg/kg) or placebo at weeks 0, 2, 6, and every 8 weeks through week 46, with placebo crossover to infliximab at week 24. Results: Of the 373 evaluated patients, 305 (81.8%) had baseline nail psoriasis. The right thumbnail was most often the worst involved nail, and pitting and onycholysis were the most common lesions. Among patients with baseline nail psoriasis, 6.9%, 26.2%, and 44.7% in the infliximab group had nail disease clearance at weeks 10, 24, and 50, respectively, versus 5.1% in the placebo group at week 24 (P < .001). Mean percent improvements in Nail Psoriasis Severity Index score at weeks 10 and 24 were 26.8% and 57.2%, respectively, in the infliximab group versus -7.7% and -4.1%, respectively, in the placebo group (both P < .001). At week 24, mean percent improvements in nail matrix and nail bed features were 52.9% and 69.2%, respectively (vs -1.9% and 18.4% for placebo; P < .001). Limitations: The study did not evaluate nail response beyond 1 year. Conclusions: Patients with psoriasis receiving infliximab experienced marked and sustained nail improvement.

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