{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:56:41Z","timestamp":1782266201110,"version":"3.54.5"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Importance:<\/jats:bold> Nail involvement is a common condition in patients with psoriasis. The treatment of nail psoriasis is considered challenging and is often left untreated by physicians.<\/jats:p><jats:p><jats:bold>Objective:<\/jats:bold> To assess the efficacy of current systemic treatments on nail psoriasis.<\/jats:p><jats:p><jats:bold>Data Sources:<\/jats:bold> PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant articles from inception to September 1, 2020. Included articles were restricted to English language and human studies.<\/jats:p><jats:p><jats:bold>Study Selection:<\/jats:bold> This was a systematic literature review with meta-analysis. Thirty-five random control trials that evaluated systemic therapies for nail psoriasis were selected in the systemic review. Among them, we retained 14 trials for meta-analysis.<\/jats:p><jats:p><jats:bold>Data Extraction and Synthesis:<\/jats:bold> This study was conducted in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. All steps were performed by two independent investigators, and any disagreements were resolved by a third investigator. Meta-analysis of aggregated study data was conducted to assess therapeutic efficacy. The use of random-effects model was based on high heterogeneity as a variable endpoint in different studies.<\/jats:p><jats:p><jats:bold>Main Outcomes and Measures:<\/jats:bold> Therapeutic effects on nail psoriasis were expressed in terms of effect sizes with 95% CIs.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> We included 35 random control trials (RCTs) in this systemic review. At baseline, a high prevalence (62.1%) of nail psoriasis was confirmed. The meta-analysis included 14 trials highlighting that biologic and small-molecule therapies were effective in treating nail psoriasis with variable effect size magnitudes [\u22120.89 (\u22121.10, \u22120.68), <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> = 84%]. In particular, tofacitinib and ixekizumab showed the most significant scale of effect size magnitudes in treating nail psoriasis (\u22121.08 points and \u22120.93 points, respectively). We also found that a higher dose of tofacitinib and ixekizumab had similar effectiveness, and anti-IL-17 agents seem to be superior in effectiveness compared to anti-TNF-\u03b1 therapies in the treatment of nail psoriasis. However, these results must be displayed carefully as variable endpoints in different studies.<\/jats:p><jats:p><jats:bold>Conclusions and Relevance:<\/jats:bold> This study provides a comprehensive overview of systemic treatments for nail psoriasis. For patients with psoriatic nail damage who are candidates of systemic therapies, the priority should be given to administering biologic and small-molecule therapies, especially anti-IL-17 drugs.<\/jats:p>","DOI":"10.3389\/fmed.2021.620562","type":"journal-article","created":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T16:09:05Z","timestamp":1612973345000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Efficacy of Systemic Treatments of Nail Psoriasis: A Systemic Literature Review and Meta-Analysis"],"prefix":"10.3389","volume":"8","author":[{"given":"Xuan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingbing","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanling","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1111\/bjd.12354","article-title":"Nail psoriasis: a questionnaire-based survey [Article]","volume":"169","author":"Klaassen","year":"2013","journal-title":"Br J Dermatol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1111\/j.1365-2133.2010.09831.x","article-title":"Nail psoriasis in Germany: epidemiology and burden of disease","volume":"163","author":"Augustin","year":"2010","journal-title":"Br J Dermatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/j.1468-3083.2009.03344.x","article-title":"Development and validation of nail psoriasis quality of life scale (NPQ10)","volume":"24","author":"Ortonne","year":"2010","journal-title":"J Eur Acad Dermatol Venereol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/S0190-9622(99)70112-X","article-title":"Psoriasis causes as much disability as other major medical diseases","volume":"41","author":"Rapp","year":"1999","journal-title":"J Am Acad Dermatol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1111\/jdv.12562","article-title":"Is there a psoriasis skin phenotype associated with psoriatic arthritis? 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