TNF Inhibitors Show Real-world Efficacy on QOL of Patients With Nail Psoriasis, PsA

Patients with concomitant psoriasis, nail psoriasis, and psoriatic arthritis (PsA) exhibited significant improvements in joint and disease severity symptoms, as well as quality of life (QOL) after 3 months of treatment with tumor necrosis factor-α (TNF) inhibitors of adalimumab, etanercept, or infliximab.

Use of tumor necrosis factor-α (TNF-α) inhibitors may significantly reduce symptom and functionality burden in patients with concomitant psoriasis, nail psoriasis, and psoriatic arthritis (PsA), according to study findings published in the Journal of Personalized Medicine.

Among patients with psoriasis, elevated incidence of PsA has been indicated to also increase risk of nail psoriasis. With nail lesions occurring in more than 80% of patients with PsA compared with nearly 40% of those without, researchers highlighted that treatment for nail psoriasis remains challenging and can significantly impact patients’ quality of life (QOL).

“Because the pathogenetic mechanisms of both psoriasis and PsA are common and mainly through T-helper cells (Th)-1 or Th-17 driven, the therapeutic strategies are largely overlapping, with minor exceptions,” they explained. “Currently, the development of new therapies for PsA follows that of psoriasis therapies since the effects of the new substances on the skin are directly visible and easier to objectify.”

Conducting a noninterventional prospective, multicenter, open-label study, researchers sought to evaluate the effectiveness of TNF-α inhibitors as the first class of biologics for treatment of patients with moderate to severe psoriasis, nail psoriasis, and PsA.

In the study, patients at 27 sites in Germany were given continuous treatment with TNF-α inhibitors, including adalimumab, etanercept, or infliximab, over 24 months (N = 100; mean [SD] age, 49.6 [12.4] years; 63% male). Participant outcomes were assessed every 3 months for the first year and twice annually thereafter via the Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), joint assessment, Dermatology Life Quality Index (DLQI), and Health Assessment Questionnaire (HAQ) instruments.

Compared with baseline, a significant reduction of NAPSI was shown 3 months after beginning TNF-α inhibitor therapy (mean [SD], 33.8 [21.4] vs 22.9 [17.8]; P < .001). NAPSI continued to radically decrease until it plateaued in month 9, with reductions still reported until the end of the observational period.

PASI was also shown to rapidly decrease from baseline to 3 months post treatment (mean [SD], 15.0 [12.5] vs 6.7 [8.8]; P < .001), with a less prominent reduction in PASI observed until month 24 (mean [SD], 3.6 [5.2]).

Furthermore, symptoms of tender and swollen joints were indicated to decrease significantly from baseline to the first 3 months of treatment (tender joints; mean [SD], 10.8 [11.5] vs 6.4 [10.3]; P < .001; swollen joints; mean [SD], 6.4 [9.5] vs 3.1 [7.2]; P < .001), respectively.

Distal interphalangeal joint involvement also improved throughout the observation time, with a more than 50% reduction reported for DLQI after 3 months compared with baseline and further improvements found in HAQ scores.

“TNF-α inhibitors are an efficacious therapy for disease control and improvement of QOL in patients with psoriasis, nail psoriasis, and concomitant PsA,” concluded the study authors. “Dermatologists should regularly monitor patients with psoriasis at risk of developing PsA and promptly initiate the appropriate therapy.”


Kokolakis G, Sabat R, Fischer I, et al. The effect of TNF-α inhibitors on nail psoriasis and psoriatic arthritis—real-world data from dermatology practice. J Pers Med. Published online October 25, 2021. doi:10.3390/jpm11111083

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