Brodalumab in the Treatment of Psoriasis Symptoms on the Scalp and Nails

Psoriasis on the Scalp and Nail Areas

Up to 80% of psoriasis patients have scalp involvement. Lesions of psoriasis on the scalp lead to complications such as itching, scarring, hair loss, and significantly diminish the quality of life. Topical application in the hair-covered area is challenging, whereas systemic treatment (methotrexate or biologics) is generally indicated for more severe cases. 

Nail involvement affects approximately half of psoriasis patients. Nail psoriasis is painful and also significantly lowers the quality of life. The treatment effect of nail psoriasis is delayed compared to other affected areas, resulting in reduced patient adherence to treatment. Both topical and biologic preparations are used; however, standardized treatment guidelines are lacking.

Analyzed Studies

The AMAGINE-1 study evaluated the reduction of scalp involvement using the PSSI (Psoriasis Scalp Severity Index) score in patients treated with brodalumab (210 mg) or placebo every 2 weeks for 12 weeks. Studies AMAGINE-2/-3 evaluated the reduction of nail involvement using the NAPSI (Nail Psoriasis Severity Index) score in patients treated with brodalumab every 2 weeks or continuously with ustekinumab for 52 weeks.     

The Effect of Brodalumab on Scalp Psoriasis

After 12 weeks of treatment, a significantly larger number of patients treated with brodalumab achieved PSSI 75 (89% brodalumab vs. 9.5% placebo) and PSSI 100 (63.5% brodalumab vs. 3.2% placebo) compared to the start of the study. Patients treated with brodalumab had a lower average PSSI score over the 12 weeks compared to the placebo group, with significant improvement in PSSI evident as early as 2 weeks of treatment.  

Average improvement from baseline PSSI over twelve weeks.
N1: number of patients with a valid measurement at the given week, PSSI: psoriasis scalp severity index, Q2W: every two weeks
*p<.001 vs. placebo

Comparison of Brodalumab and Ustekinumab in Nail Psoriasis Treatment

Over 52 weeks, more patients treated with brodalumab achieved complete clearance of nail psoriasis compared to ustekinumab − at week 52, NAPSI 0 was achieved in 63.8% of patients treated with brodalumab compared to 39.1% treated with ustekinumab. Patients on brodalumab had a lower average NAPSI score and a higher average improvement percentage from baseline NAPSI compared to those on ustekinumab after one year of treatment.

Percentage of patients with NAPSI 0 at weeks 12, 24, and 52 continuing with brodalumab 210 mg every two weeks (Q2W) or ustekinumab.
N1: number of patients with a valid measurement at the given week, NAPSI: nail psoriasis severity index, Q2: every two weeks.  *p<.0.5 vs. ustekinumab. 

Conclusion

Brodalumab has proven effective in significantly reducing or resolving psoriasis symptoms on the scalp after 12 weeks of treatment, and similarly exhibited high efficacy in the treatment of nail psoriasis after 52 weeks. 

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Source: Elewski B., Rich P., Lain E. et al. Efficacy of brodalumab in the treatment of scalp and nail psoriasis: results from three phase 3 trials. J Dermatol Treat 2020 Apr 21, doi: 10.1080/09546634.2020.1749546 [Epub ahead of print].