IL-17A in the treatment of nail psoriasis

Abstract

BACKGROUND: Psoriasis is an inflammatory skin disease that significantly worsens the quality of the patients life. With vulgar psoriasis, the most common form of the disease, nail damage is observed in more than 50% of cases. AIMS: To evaluate the efficacy and tolerability of secukinumab in the treatment of nail psoriasis (psoriatic onychodystrophy) in real clinical practice. MATERIALS AND METHODS: The study was carried out on the basis of the Clinic for Skin and Venereal Diseases. V.A. Rakhmanov Sechenov University. The participants were 12 patients diagnosed with psoriasis, aged 29 to 60 years. All patients were diagnosed with a severe degree, 2 (16.7%) patients ― psoriatic erythroderma, 10 (83.3%) ― psoriasis vulgaris, all studied patients had nail plate lesions. All patients were treated with a genetically engineered biological drug ― an IL-17A inhibitor secukinumab (Cosentix), 300 mg subcutaneously once a week (5 injections), followed by a maintenance dose of 300 mg once a month. The course of therapy was 20 weeks (9 injections). Assessment of the severity of nail psoriasis and the effectiveness of therapy was carried out using indices: NAPSI (index of the degree of damage to the nail plates), DLQI (dermatological index of quality of life), which were studied in dynamics before treatment and after 20 weeks of treatment. RESULTS: The NAPSI index was 25.33.4 points before treatment, and at week 20 it decreased to 2.20.7 points. These results demonstrate a regression of clinical manifestations by more than 80% from the initial state of the nails. When assessing the dermatological index of quality of life (DLQI), it was found that in the study group of patients before the start of treatment, it was 27.42.1 points, which reflected a strong negative effect of psoriasis on the quality of life of patients. After treatment, this indicator was 3.10.5 points among all patients. No patient experienced any side effects from the therapy. CONCLUSIONS: Secukinumab is a highly effective and safe drug for the treatment of nail psoriasis in patients with vulgar psoriasis and psoriatic erythroderma and contributes to improve the quality of the patients life.