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Journal of the American Academy of Dermatology
Volume 58, n° 2
pages 224-231 (février 2008)
Doi : 10.1016/j.jaad.2007.07.042
accepted : 28 July 2007
Baseline nail disease in patients with moderate to severe psoriasis and response to treatment with infliximab during 1 year

Phoebe Rich, MD a, , Christopher E.M. Griffiths, MD b, Kristian Reich, MD c, Frank O. Nestle, MD d, Richard K. Scher, MD e, Shu Li, MS f, Stephen Xu, MS f, Ming-Chun Hsu, PhD f, Cynthia Guzzo, MD f
a Oregon Health Sciences University, Portland, Oregon 
b Dermatology Centre, Hope Hospital, University of Manchester, Manchester, United Kingdom 
c Department of Dermatology, Georg-August University, Göttingen, Germany 
d St John’s Institute of Dermatology, King’s College London School of Medicine, London, United Kingdom 
e Department of Dermatology, Columbia University, New York, New York 
f Centocor Inc, Malvern, Pennsylvania 

Reprint requests: Phoebe Rich, MD, Oregon Health Sciences University, Dermatology and Clinical Research, 2565 NW Lovejoy St, Suite 200, Portland, OR 97210.

Although nail psoriasis occurs frequently in patients with psoriatic skin lesions, effective treatments are limited.


Occurrence of nail psoriasis by type and incidence of nail clearance using the Nail Psoriasis Severity Index were evaluated.


This was a 50-week, phase III study in which 378 patients with moderate to severe psoriasis were randomized 4:1 to infliximab (5 mg/kg) or placebo at weeks 0, 2, 6, and every 8 weeks through week 46, with placebo crossover to infliximab at week 24.


Of the 373 evaluated patients, 305 (81.8%) had baseline nail psoriasis. The right thumbnail was most often the worst involved nail, and pitting and onycholysis were the most common lesions. Among patients with baseline nail psoriasis, 6.9%, 26.2%, and 44.7% in the infliximab group had nail disease clearance at weeks 10, 24, and 50, respectively, versus 5.1% in the placebo group at week 24 (P < .001). Mean percent improvements in Nail Psoriasis Severity Index score at weeks 10 and 24 were 26.8% and 57.2%, respectively, in the infliximab group versus –7.7% and –4.1%, respectively, in the placebo group (both P < .001). At week 24, mean percent improvements in nail matrix and nail bed features were 52.9% and 69.2%, respectively (vs –1.9% and 18.4% for placebo; P < .001).


The study did not evaluate nail response beyond 1 year.


Patients with psoriasis receiving infliximab experienced marked and sustained nail improvement.

The full text of this article is available in PDF format.

Abbreviations used : EXPRESS, NAPSI, PASI, PsA

 Supported by Centocor Inc, Malvern, Pa, and Schering-Plough, Kenilworth, NJ.
 Disclosure: Dr Rich has received advisory board honoraria from Abbott and investigator grants from Centocor, Wyeth, and Genentech. Dr Griffiths has received grants and/or honoraria as a speaker, investigator, and/or advisory member for Centocor, Wyeth, Schering-Plough, Serono, UCB, Abbott, Novartis, Galderma, Leo, and Novo Nordisk. Dr Reich has received honoraria as a consultant, investigator, speaker, and advisory board member for Centocor and Schering Plough. Dr Nestle has received honoraria as a consultant, speaker, and advisory board member for Centocor. Dr Scher has received honoraria as a consultant, advisory broad member, and/or speaker for Centocor, Stiefel Laboratories, Allergan, Galderma, Medicis, and Biovail. Dr Guzzo and Ms Li receive employee salaries and have received stock and stock options from Centocor. Dr Hsu and Mr Xu receive employee salaries from Centocor.
 Partially presented as an abstract and as a poster at the American Academy of Dermatology Annual Meeting, Washington, DC, February 2007 and at the American Academy of Dermatology Summer Meeting, San Diego, California, July 2006.

© 2008  American Academy of Dermatology, Inc.@@#104156@@
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