Plaque psoriasis causes red patches, rashes, and scales on the skin and nails. Patients notice moderate to severe dry, raised, and red lesions with silvery scales. Cytokines like interleukin (IL)-17A and IL-23p19 aggravate this problem. Ixekizumab and Guselkumab antibodies help inhibit these proteins, respectively. This study compares the long-term efficacy of these two antibody types.

The IXORA-R study group conducted a head-on-head trial between Ixekizumab and Guselkumab. The objective was to compare nail and skin clearance. The Psoriasis Area and Severity Index (PASI 100) was the base to report patient outcomes for up to 24 weeks. About 1027 patients were randomized, and 90% of them completed the trial. Researchers used Ixekizumab for 465 out of 520 participants, and 459 out of 507 took Guselkumab. Primary techniques used are statistical comparison and Kaplan-Meier analysis. The ANCOVA method compared cumulative clinical days and patient-reported responses. The p values got stratified for the treatment group and adjusted using a log-rank test.

From Week 2 through Week 16, Ixekizumab achieved 100 PASI with p< 0.001. At Week 24, Ixekizumab (50%) and Guselkumab (52%) difference was -2.3%. The nail clearance at Week 24 was 52% to 31% in favor of Ixekizumab. These patients also received greater cumulative benefits. They had more days at PASI 90 and 100. Their life quality improved, and the itch-free metric was p< 0.05. Only 3% in each group had a severe adverse event frequency. 

Ixekizumab cleared skin and nails more rapidly in moderate to severe cases. It was non-inferior, and the overall safety findings were consistent with the known safety profiles.

Ref: https://onlinelibrary.wiley.com/doi/10.1111/bjd.19509