A 24-week randomized clinical trial investigating the efficacy and safety of two doses of etanercept in nail psoriasis

Background Nail psoriasis is common in patients with psoriasis and can seriously affect their quality of life. Current treatments are limited and there is no standard course of therapy. Objectives To assess the efficacy and safety of etanercept (ETN) on nail psoriasis in patients with moderate-to-severe psoriasis. Methods Patients with moderate-to-severe plaque psoriasis, who had previously failed at least one form of systemic therapy for nail psoriasis, were randomized to receive open-label ETN 50mg twice weekly (BIW) for 12 weeks followed by once weekly (QW) for 12weeks (BIW/QW group) or ETN 50mg QW for 24 weeks (QW/QW group). The primary endpoint was the mean improvement in the Nail Psoriasis Severity Index (NAPSI; score range 08) over 24 weeks in the target fingernail with the most severe abnormalities. Results Seventy-two patients received one or more doses of ETN (38 BIW/QW; 34 QW/QW) and 69 patients were included in the modified intent-to-treat population. At baseline, mean (standard error) target fingernail NAPSI score was 6.0 (0.3) in the BIW/QW group and 5.8 (0.3) in the QW/QW group. At week 24, mean target fingernail NAPSI score had decreased significantly by -4.3 [95% confidence interval (CI) -4.9 to -3.7; P<0.0001] in the BIW/QW group and by -4.4 (95% CI -5.0 to -3.7; P<0.0001) in the QW/QW group. Improvement in NAPSI showed significant correlation with Psoriasis Area and Severity Index improvement. ETN was well tolerated with no unexpected safety findings. Conclusions Both ETN regimens were effective at treating nail psoriasis in this patient population.