New Research Confirms Effective Therapy for Nail Psoriasis

In a recent interview with Dermatology Times, Paul Yamauchi, MD, PhD, a board-certified dermatologist at the Dermatology Institute and Skincare Center in Santa Monica, California, spoke about his involvement in a clinical trial evaluating the efficacy of tildrakizumab, a biologic therapy, in treating moderate to severe nail psoriasis. In addition to his private practice, Yamauchi has conducted over 200 clinical trials through the Clinical Science Institute, a research center he founded.

During the interview, Yamauchi emphasized the importance of specific trials for these subgroups of psoriasis patients, stating, "Placebo-controlled trials provide more accurate and reliable data than post hoc analysis."

The study focused on 2 primary endpoints measured at week 28, given that nails grow slowly and require extended observation periods for assessment. The first endpoint was the modified Nail Psoriasis Severity Index (NAPSI) score, which evaluates characteristics such as pitting, nail separation, thickening, and discoloration. According to Yamauchi, a 75% improvement in the modified NAPSI score was observed in 25% of subjects receiving tildrakizumab, compared to only 4.2% in the placebo group The second endpoint was the Visual Index for Severity of Nail Psoriasis (VISNAP), a 5-point scale developed by Sun Pharmaceuticals. Yamauchi explained, "For the VISNAP response at week 28, 29% of subjects attained clear or almost clear nails, compared to a placebo rate of 4.2%." This significant separation between the treatment and placebo groups suggests that tildrakizumab is effective for treating nail psoriasis.

Yamauchi previously investigated tildrakizumab for scalp psoriasis, another high-impact area, which also met its primary endpoints. Yamauchi noted that Sun Pharmaceuticals is planning further trials for genital, hand, and foot psoriasis. He mentioned that topical therapies are typically the first-line treatment for nail and scalp psoriasis. However, if topical treatments fail, systemic options such as pills or injections become necessary. He highlighted tildrakizumab’s advantage, stating, "Since it is administered every3 months, it is very convenient for the patient and a safe product, making it a good choice as a first-line systemic agent."

Safety was another crucial aspect discussed in the trial. Tildrakizumab demonstrated a favorable safety profile, with the most common adverse effects being minor infections. The drug had no significant warnings beyond this, reinforcing its potential as a viable treatment option.

Yamauchi's insights underscore the promising role of tildrakizumab in treating nail psoriasis. The placebo-controlled trial's strong efficacy results, combined with the drug’s safety and convenience, make it a compelling option for patients who do not respond adequately to topical therapies. Additionally, ongoing research may expand its indications to other challenging psoriasis-affected areas, providing further therapeutic options for patients.