Efficacy of Systemic Treatments of Nail Psoriasis: A Systemic Literature Review and Meta-Analysis
Importance: Nail involvement is a common condition in patients with psoriasis. The treatment of nail psoriasis is considered challenging and is often left untreated by physicians.Objective: To assess the efficacy of current systemic treatments on nail psoriasis.Data Sources: PubMed, EMBASE, and Coch...
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doaj-5d7c364472d4493eb3132724e0a403492021-02-10T07:23:38ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-02-01810.3389/fmed.2021.620562620562Efficacy of Systemic Treatments of Nail Psoriasis: A Systemic Literature Review and Meta-AnalysisXuan Zhang0Bingbing Xie1Yanling He2Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, ChinaDepartment of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaImportance: Nail involvement is a common condition in patients with psoriasis. The treatment of nail psoriasis is considered challenging and is often left untreated by physicians.Objective: To assess the efficacy of current systemic treatments on nail psoriasis.Data Sources: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant articles from inception to September 1, 2020. Included articles were restricted to English language and human studies.Study Selection: This was a systematic literature review with meta-analysis. Thirty-five random control trials that evaluated systemic therapies for nail psoriasis were selected in the systemic review. Among them, we retained 14 trials for meta-analysis.Data Extraction and Synthesis: This study was conducted in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. All steps were performed by two independent investigators, and any disagreements were resolved by a third investigator. Meta-analysis of aggregated study data was conducted to assess therapeutic efficacy. The use of random-effects model was based on high heterogeneity as a variable endpoint in different studies.Main Outcomes and Measures: Therapeutic effects on nail psoriasis were expressed in terms of effect sizes with 95% CIs.Results: We included 35 random control trials (RCTs) in this systemic review. At baseline, a high prevalence (62.1%) of nail psoriasis was confirmed. The meta-analysis included 14 trials highlighting that biologic and small-molecule therapies were effective in treating nail psoriasis with variable effect size magnitudes [−0.89 (−1.10, −0.68), I2 = 84%]. In particular, tofacitinib and ixekizumab showed the most significant scale of effect size magnitudes in treating nail psoriasis (−1.08 points and −0.93 points, respectively). We also found that a higher dose of tofacitinib and ixekizumab had similar effectiveness, and anti-IL-17 agents seem to be superior in effectiveness compared to anti-TNF-α therapies in the treatment of nail psoriasis. However, these results must be displayed carefully as variable endpoints in different studies.Conclusions and Relevance: This study provides a comprehensive overview of systemic treatments for nail psoriasis. For patients with psoriatic nail damage who are candidates of systemic therapies, the priority should be given to administering biologic and small-molecule therapies, especially anti-IL-17 drugs.https://www.frontiersin.org/articles/10.3389/fmed.2021.620562/fullnailpsoriasissystemic treatmentssystemic reviewmeta-analysis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Xuan Zhang Bingbing Xie Yanling He |
spellingShingle |
Xuan Zhang Bingbing Xie Yanling He Efficacy of Systemic Treatments of Nail Psoriasis: A Systemic Literature Review and Meta-Analysis Frontiers in Medicine nail psoriasis systemic treatments systemic review meta-analysis |
author_facet |
Xuan Zhang Bingbing Xie Yanling He |
author_sort |
Xuan Zhang |
title |
Efficacy of Systemic Treatments of Nail Psoriasis: A Systemic Literature Review and Meta-Analysis |
title_short |
Efficacy of Systemic Treatments of Nail Psoriasis: A Systemic Literature Review and Meta-Analysis |
title_full |
Efficacy of Systemic Treatments of Nail Psoriasis: A Systemic Literature Review and Meta-Analysis |
title_fullStr |
Efficacy of Systemic Treatments of Nail Psoriasis: A Systemic Literature Review and Meta-Analysis |
title_full_unstemmed |
Efficacy of Systemic Treatments of Nail Psoriasis: A Systemic Literature Review and Meta-Analysis |
title_sort |
efficacy of systemic treatments of nail psoriasis: a systemic literature review and meta-analysis |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2021-02-01 |
description |
Importance: Nail involvement is a common condition in patients with psoriasis. The treatment of nail psoriasis is considered challenging and is often left untreated by physicians.Objective: To assess the efficacy of current systemic treatments on nail psoriasis.Data Sources: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant articles from inception to September 1, 2020. Included articles were restricted to English language and human studies.Study Selection: This was a systematic literature review with meta-analysis. Thirty-five random control trials that evaluated systemic therapies for nail psoriasis were selected in the systemic review. Among them, we retained 14 trials for meta-analysis.Data Extraction and Synthesis: This study was conducted in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. All steps were performed by two independent investigators, and any disagreements were resolved by a third investigator. Meta-analysis of aggregated study data was conducted to assess therapeutic efficacy. The use of random-effects model was based on high heterogeneity as a variable endpoint in different studies.Main Outcomes and Measures: Therapeutic effects on nail psoriasis were expressed in terms of effect sizes with 95% CIs.Results: We included 35 random control trials (RCTs) in this systemic review. At baseline, a high prevalence (62.1%) of nail psoriasis was confirmed. The meta-analysis included 14 trials highlighting that biologic and small-molecule therapies were effective in treating nail psoriasis with variable effect size magnitudes [−0.89 (−1.10, −0.68), I2 = 84%]. In particular, tofacitinib and ixekizumab showed the most significant scale of effect size magnitudes in treating nail psoriasis (−1.08 points and −0.93 points, respectively). We also found that a higher dose of tofacitinib and ixekizumab had similar effectiveness, and anti-IL-17 agents seem to be superior in effectiveness compared to anti-TNF-α therapies in the treatment of nail psoriasis. However, these results must be displayed carefully as variable endpoints in different studies.Conclusions and Relevance: This study provides a comprehensive overview of systemic treatments for nail psoriasis. For patients with psoriatic nail damage who are candidates of systemic therapies, the priority should be given to administering biologic and small-molecule therapies, especially anti-IL-17 drugs. |
topic |
nail psoriasis systemic treatments systemic review meta-analysis |
url |
https://www.frontiersin.org/articles/10.3389/fmed.2021.620562/full |
work_keys_str_mv |
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1724275529801007104 |