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J Am Acad Dermatol. 2008 Feb;58(2):224-31. Epub 2007 Dec 20.

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

Author information

1
Oregon Health Sciences University, Dermatology and Clinical Research, Portland, Oregon 97210, USA. phoeberich@aol.com

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.

PMID:
18083272
DOI:
10.1016/j.jaad.2007.07.042
[Indexed for MEDLINE]

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