Which medication is most effective for nail psoriasis?

A systematic review and network meta-analysis of studies assessing small molecule inhibitors and biologic drugs show that tofacitinib and ixekizumab are the most effective treatments for nail psoriasis in 10 to 16 weeks and 24 to 26 weeks, respectively.

“Various systemic immunomodulating therapies have been investigated to treat nail psoriasis, but the efficacy remains unclear,” the investigators noted.

To address this, they identified eligible studies in online databases until 10 March 2020. A network meta-analysis was performed with surface under the cumulative ranking curve of improvement in nail score, as well as 100-percent improvement of Nail Psoriasis Severity Index (NAPSI) to examine the efficacy of small molecule inhibitors and biologics.

Thirty-nine studies with 13 treatment arms, including a total of 15,673 patients with nail psoriasis, met the eligibility criteria. Use of tofacitinib (weighted mean difference [WMD], 56.67, 95 percent confidence interval [CI], 35.87–77.48) and ixekizumab (WMD, 59.40, 95 percent CI, 45.87–72.93) provided the most improvement in nail score at 10 to 16 weeks and 24 to 26 weeks, respectively.

Among all treatments, ixekizumab presented the best efficacy for 100-percent improvement of the Nail Psoriasis Severity Index (odds ratio, 2.98, 95 percent CI, 1.74–5.10).

Of note, this systematic review and network meta-analysis was limited by insufficiency of eligible data and absence of long-term follow-up data, according to the investigators.