European study shows infliximab effective for nail psoriasis

New York - According to a post-hoc analysis of the European Infliximab for Psoriasis (Remicade) Efficacy and Safety Study, infliximab is highly effective for treatment of psoriatic nail disease, Reuters Health reports.

The analysis, reported in the February issue of the Journal of the American Academy of Dermatology, notes that conventional treatment of nails affected by psoriasis is difficult and often ineffective. The European study itself, however, suggests that infliximab works well in combating the affliction.

The study involved 378 severe-psoriasis patients, about 82 percent of whom suffered from nail psoriasis. Patients were randomized in a 4:1 ratio to receive either infliximab or placebo.

In the infliximab group, 240 patients were treated with 5 mg/kg IV at weeks zero, two and six, then every eight weeks through week 46. The 65 patients in the placebo group began receiving a similar dosage of infliximab at week 24.

Nail Psoriasis Severity Index (NAPSI) scores for nail involvement averaged 4.6 in the treatment group and 4.3 in placebo patients at baseline. At weeks 10 and 24, NAPSI scores in the treatment group had improved by 26.8 percent and 57.2 percent, respectively.

Targeted nail psoriasis had cleared completely in 6.9 percent of patients at week 10 and in 44.7 percent at week 50.

In the placebo group, mean NAPSI scores declined over the first half of the trial. After the group began receiving infliximab, however, results in this group “were more consistent with those observed in the patients originally randomized to infliximab,” researchers write.

According to the analysis, lunula red spots and splinter hemorrhages in the nail bed responded well to infliximab. Nail matrix pitting, the manifestation slowest to respond, persisted in 44 percent of treated patients at week 50.