13771 Comparison of ixekizumab and adalimumab in the treatment of nail psoriasis in psoriatic arthritis patients with moderate to severe psoriasis: 24-week results from a multicenter, randomized, open-label, rater-blinded study (SPIRIT-H2H)

Objective: Nail psoriasis is common in patients with psoriatic arthritis (PsA) and plaque psoriasis (PsO), causing pain and impaired hand mobility. This analysis evaluated the efficacy of two biologic disease-modifying antirheumatic drugs (bDMARDs), ixekizumab and adalimumab, for treating nail psoriasis in patients with active PsA and moderate to severe PsO (Psoriasis Area and Severity Index score ≥12, static Physicians Global Assessment score ≥3 and body surface area involvement ≥10%). Methods: SPIRIT-H2H was a randomised, open-label, rater-blinded study evaluating the efficacy and safety of ixekizumab versus adalimumab in adults with active PsA and PsO naïve to bDMARDs. This post hoc subgroup analysis examined the efficacy of both treatments in PsA patients with moderate to severe PsO and nail psoriasis (baseline Nail Psoriasis Severity Index (NAPSI) score ≥1). Differences in NAPSI scores between treatments (mixed models for repeated measurement), and the proportions of complete responders (NAPSI score 0; logistic regression model) were determined to 24 weeks. Results: Baseline NAPSI scores were ≥ 1 in 75.5% of the analysis population receiving ixekizumab (37/49) and 80.4% receiving adalimumab (41/51), ≥16 in 56.8% and 58.5%, and ≥40 in 27.0% and 17.1%, respectively. NAPSI scores improved for both treatments throughout the study, with a numerically greater reduction from baseline (−20.7 vs −16.3, P =.076) and significantly greater proportion of complete responders (80.0% vs 52.5%; P =.009) with ixekizumab than adalimumab at week 24. Conclusions: In this post hoc analysis, ixekizumab showed higher rates of complete resolution of nail involvement than adalimumab at week 24, confirming the established efficacy of ixekizumab in nail psoriasis.