P169 Treatment effects of ixekizumab and adalimumab at the individual digit level with nail and distal interphalangeal joint involvement in patients with psoriatic arthritis
Authors: McGonagle Dennis , Kavanaugh Arthur , McInnes Iain , Kristensen Lars-Erik , Merola Joseph F , Strober Bruce E , Lisse Jeffrey R , Pustizzi Jennifer , Sapin Christophe , Bolce Rebecca , Ritchlin Christopher 
Published: April 2023

Abstract

Background/Aims
Psoriatic nail disease is intimately linked to adjacent distal interphalangeal joint (DIP) disease, and it is important to ascertain whether DIP-nail complex behaves differently under different biological therapies. The aim of this analysis is to assess the effect of ixekizumab (IXE) and adalimumab (ADA) at the individual digit level using the Nail Psoriasis Severity Index (NAPSI) and NAPSI resolution in patients with psoriatic arthritis (PsA) with concomitant nail involvement.

Methods
This post hoc analysis included patients from SPIRIT-H2H (NCT03151551) treated with either IXE or ADA who had baseline nail disease (NAPSI total score &gt;0) and DIP involvement, with either tenderness or swelling, at the individual digit level for each hand. Nail disease was assessed using the NAPSI scoring system, a measure of nail bed and nail matrix involvement combined for a total maximum score of 80. Proportions of patients having a NAPSI total score &gt;0 were evaluated at baseline, week 24 and week 52; post-baseline assessments were compared between treatment using Fisher’s exact test.

Results
Of 566 patients in the intent-to-treat SPIRIT-H2H population of, 354 patients (IXE, N = 186; ADA, N = 168) had NAPSI total score &gt;0 and DIP involvement in at least 1 of 10 digits simultaneously at baseline. At week 24, the proportion of patients with nail disease (NAPSI &gt;0) was lower among patients who received IXE versus ADA across all 10 digits and was significantly lower versus ADA for 9 out of the 10 individual digits (p &lt; 0.05; Table) with additional improvements out to week 52. On average, a 10% difference in the proportion of patients with NAPSI &gt;0 at week 24 between IXE and ADA at the individual digit level was observed, favouring IXE. Similarly, numerically greater improvements were observed with IXE compared to ADA regardless of whether nail bed, nail matrix, or NAPSI total score was assessed.

Conclusion
These data demonstrate that in patients with PsA with nail involvement, there was a significant advantage of IXE over ADA in resolving nail involvement at the individual digit level as measured by NAPSI.
Disclosure
D. McGonagle: Consultancies; Eli Lilly and Company, AbbVie. Member of speakers’ bureau; Eli Lilly and Company. Grants/research support; Eli Lilly and Company. Other; BSR attendance support from Eli Lilly and Company. A. Kavanaugh: Consultancies; AbbVie, UCB, Janssen, Novartis, Pfizer. I. McInnes: Consultancies; AbbVie, Amgen, BMS, Causeway Therapeutics, Cabaletta, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, Sanofi Regeneron, UCB. Grants/research support; AbbVie, Amgen, BMS, Causeway Therapeutics, Cabaletta, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, Sanofi Regeneron, UCB Pharma. Other; University of Glasgow, Vice Principal & Head of College, NHS Greater Glasgow & Clyde, Non exec board member, Evelo, Board of Directors, Non Exec director, Versus arthritis, Trustee. L. Kristensen: Consultancies; Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly and Company, Janssen. Member of speakers’ bureau; Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly and Company, Janssen. Grants/research support; Pfizer, AbbVie, UCB, Gilead, Biogen, Novartis, Eli Lilly and Company, Janssen. Other; study grant from Novo Nordisk A/S, institutional grant from The Oak Foundation, Cambridge Weight Plan, delivery of dietary supplements. J.F. Merola: Consultancies; Amgen, Bristol-Myers Squibb, AbbVie, Dermavant, Eli Lilly and Company, Novartis, Janssen, UCB, Sanofi, Regeneron, Sun Pharma, Biogen, Pfizer, Leo Pharma. B.E. Strober: Consultancies; AbbVie, Alumis, Almirall, Amgen, Arcutis, Arena, Aristea, Asana, Boehringer Ingelheim, Immunic Therapeutics, Bristol-Myers-Squibb, Connect Biopharma, Dermavant, EPI Health, Evelo Biosciences, Janssen, Leo, Eli Lilly and Company, Maruho, Meiji Seika Pharma, Mindera Health, Novartis, Pfizer, UCB Pharma, Sun Pharma, Regeneron, Sanofi-Genzyme, Union Therapeutics, Ventyxbio, vTv Therapeutics. Shareholder/stock ownership; Connect Biopharma, Mindera Health. Honoraria; Editor-in-Chief (honorarium): Journal of Psoriasis and Psoriatic Arthritis. Member of speakers’ bureau; AbbVie, Eli Lilly and Company, Incyte, Janssen, Regeneron, Sanofi-Genzyme. Other; Investigator: Dermavant, Investigator: AbbVie, Investigator: CorEvitas Psoriasis Registry, Investigator: Dermira, Investigator: Cara, Investigator: Novertis. J.R. Lisse: Corporate appointments; Eli Lilly and Company. Shareholder/stock ownership; Eli Lilly and Company. J. Pustizzi: Corporate appointments; Eli Lilly and Company. Shareholder/stock ownership; Eli Lilly and Company. C. Sapin: Corporate appointments; Eli Lilly and Company. Shareholder/stock ownership; Eli Lilly and Company. R. Bolce: Corporate appointments; Eli Lilly and Company. Shareholder/stock ownership; Eli Lilly and Company. C. Ritchlin: Consultancies; AbbVie, Janssen, Novartis, BMS, UCB. Member of speakers’ bureau; Pfizer, UCB, AbbVie. Grants/research support; Pfizer, AbbVie.