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Adalimumab Clears Nail Disease in Psoriatic Arthritis

— Nail involvement often overlooked

Ƶ MedicalToday

LIVERPOOL -- Nail disease in patients with psoriatic arthritis responded rapidly and significantly to treatment with adalimumab (Humira), a real-world study found.

Among 36 patients with psoriatic arthritis who had nail involvement at baseline, mean Bath nail scores declined from 5.8 at baseline to 2.8 at 3 months, according to William Tillett, MBBS, of the Royal National Hospital for Rheumatic Diseases in Bath, England, and colleagues.

This reduction in nail score further decreased with longer follow-up, with mean scores of 1.4 at 6 months, 1.7 at 12 months, 2.4 at 18 months, 1.7 at 24 months, and 0.9 at 36 months, Tillett reported during a poster session at the here.

"Nail disease represents an unmet need in psoriatic arthritis. Unlike the joints, it's typically seen as being not a significant aspect of the disease," he told Ƶ.

Typical manifestations of nail disease include pitting, onycholysis, hyperkeratosis, or even severe deformity that can lead to impairments in physical capability, pain and reduced quality of life, he said.

Tumor necrosis factor inhibitors have been shown to be helpful for nail symptoms, but long-term data have been lacking.

To address this knowledge gap, Tillett and colleagues collected data from their hospital for patients with psoriatic arthritis who had received adalimumab. The data included age, gender, duration of psoriatic arthritis, nail scores and Psoriasis Area and Severity Index (PASI) scores.

At baseline, patients' mean age was 55, with a mean disease duration of 10.1 years, and almost two-thirds were men. Mean age was 40 at the time of psoriatic arthritis diagnosis. Mean PASI score was 5.

Median nail scores decreased from 4 at baseline to 2 at 3 months, and by 6 months had fallen to 0, where they remained through 36 months.

Similar results were seen for PASI scores, declining from a mean of 5 at baseline to 2.2 at 3 months and 1.5 at 6 months. By 36 months, mean PASI score was 1.8. For median scores, there was a decline from 2.7 at baseline to 1.5 at 3 months, and to 0.3 by 36 months.

There was no nail disease activity in 62% of patients at month 6, and in 64% at month 36. For PASI scores, 35% had no activity at 6 months, and 36% had no activity at 36 months.

Adalimumab treatment was ongoing at month 36 for 61% of patients. Among the 14 patients who had stopped treatment, 14% had no nail activity at the most recent assessment, 8% had switched to another treatment with some ongoing nail activity, and the remainder had no data available.

"The study shows that adalimumab rapidly resolved nail disease and improvements persisted to 36 months. This was an observational real-world study that builds on information regarding which therapies could be beneficial for nails," Tillett said.

Disclosures

Tillett and co-authors reported various relationships with industry, including AbbVie (the maker of adalimumab), with one co-author working for the company.

Primary Source

British Society for Rheumatology

McHugh N, et al "Improvement of psoriatic nail disease in psoriatic arthritis patients treated with adalimumab: results of an observational cohort up to 36 months" BSR 2018; Abstract 187.