Nail Psoriasis: Which Biologic should I Choose?

The presentation discusses the complexities of choosing the appropriate biologic treatment for nail psoriasis, focusing on three critical factors: comorbidities, patient profiles, and drug efficacy. It highlights the importance of evaluating comorbidities in psoriasis treatment and emphasizes the evolving understanding of psoriasis pathogenesis, particularly the role of interleukins 17 and 23. Recent studies are referenced to showcase various biologics' efficacy in treating nail psoriasis, including anti-TNF drugs, IL-12/23 inhibitors, and newer IL-17 and IL-23 interventions, such as secukinumab, ixekizumab, and brodalumab. The speaker notes that while some biologics work faster (like anti-IL-17 inhibitors), others may provide more durable results over time (like anti-IL-23 inhibitors). Meta-analyses indicate that secukinumab may have the highest efficacy for complete resolution within 24 to 52 weeks. Ultimately, the choice of therapy should be tailored to the patient's specific needs, and future randomized controlled trials are needed to clarify the optimal approaches to treatment, as a significant portion of patients with psoriasis also experiences nail damage.