BH06 Monitoring of nail psoriasis with optical coherence tomography under treatment with tildrakizumab for 52 weeks

Abstract

Nail psoriasis is associated with psoriasis arthritis (PsA) and higher disease burden. Clinical scores like the Nail Psoriasis Severity Index (NAPSI) capture only clinical changes, whereas optical coherence tomography (OCT) allows noninvasive imaging of the nail plate and nailbed up to 2-mm depth. The aim of the study was to evaluate response of nail psoriasis to tildrakizumab over 52 weeks. This prospective, single-centre study included 20 patients with psoriasis vulgaris and nail psoriasis, initiating tildrakizumab treatment. Assessments were performed at baseline and every 12 weeks over a year, with OCT scans on all nails at each visit. In total 1816 nail examinations from 15 male and 5 female patients were performed using OCT. Significant remission of nail plate and subungual changes in OCT were observed over 52 weeks (all P < 0.001). NAPSI decreased significantly from baseline to week 52 (P < 0.001). OCT demonstrated earlier remission in the nail matrix (week 12) than NAPSI (week 24), while in the nailbed both methods showed significant remission at week 12. Fingernails were less affected at baseline in OCT scans and responded faster to treatment than toenails. OCT seems to complement clinical examination of nail psoriasis by detecting early therapeutic effects and subclinical changes.