Small molecule inhibitors and biologics in treating nail psoriasis: a systematic review and network meta-analysis.

Abstract Background Various systemic immunomodulating therapies have been investigated to treat nail psoriasis, but the efficacy remains unclear. Objective To perform a systematic review and network meta-analysis (NMA) to evaluate the efficacy of small molecule inhibitors and biologics in treating nail psoriasis. Methods Eligible studies in online databases were identified until March 10, 2020. To assess the efficacy of small molecule inhibitors and biologics, network meta-analyses with surface under the cumulative ranking curve of improvement in nail score in 10–16 and 24–26 weeks, and 100% improvement of Nail Psoriasis Severity Index (NAPSI) were performed. Results Thirty-nine studies of total 13 treatment arms involving 15,673 patients with nail psoriasis were included. An NMA revealed that tofacitinib (weighted mean difference[WMD] 63.57, 95% confidence interval[CI] 41.67–85.48) and ixekizumab (WMD 59.40, 95% CI 45.87–72.93) presented the most improvement of nail score at 10–16 weeks and 24–26 weeks, respectively. For 100% improvement of NAPSI, ixekinumab showed the best efficacy among all treatments (odds ratio 3.22, 95% CI 1.72–6.01). Limitations Insufficiency of eligible data and no long-term follow-up data. Conclusion Tofacitinib and ixekizumab presented the best efficacy for treating nail psoriasis in 10–16 weeks and 24–26 weeks, respectively.