Efficacy and Safety of Subcutaneous Anti-Tumor Necrosis Factor-Alpha Agents, Etanercept and Adalimumab, in Elderly Patients Affected by Psoriasis and Psoriatic Arthritis: An Observational Long-Term Study

Abstract

Background: In elderly patients the management of psoriasis is challenging due to contraindications and a higher risk of side effects. Objective: Our retrospective study aimed to evaluate the long-term efficacy and safety profile of subcutaneous anti-tumor necrosis factor (anti-TNF) agents in elderly psoriatic patients. Methods: The study included 89 patients (aged ≥65 years) with plaque-type psoriasis and psoriatic arthritis treated with the subcutaneous anti-TNF-α agents etanercept or adalimumab as monotherapy for a long-term continuous period. Results: Efficacy results were consistent and stable over long-term observation, as expressed by mean Psoriasis Area and Severity Index (PASI) score variation, percentage of patients achieving PASI50 and PASI75 and by the improvement of articular indices, pain visual analogue scale (Pain-VAS) and 44-Joint Disease Activity Score (DAS44-ESR). The proportion of patients achieving PASI50 was 91.80 and 82.14% at week 156 with etanercept and adalimumab treatment, respectively, while the proportion of patients achieving PASI75 was 83.61 and 71.43% at week 156 when treated with etanercept and adalimumab, respectively. The mean DAS44-ESR score decreased from 5.80 to 0.89 and from 3.43 to 1.44 at week 156 and the mean Pain-VAS score decreased from 75.10 to 3.15 and from 71.30 to 18.26 at week 156 with etanercept and adalimumab treatment, respectively. Both treatment adherence and safety profile were good. Conclusions: Our study demonstrates that subcutaneous anti-TNF-α agents are appropriate in the long-term management of elderly patients.

Long term efficacy and safety of etanercept in the treatment of psoriasis and psoriatic arthritis

“…Rates of SAEs in this study were higher in the older group, but this difference was considered unrelated to etanercept treatment 69. Furthermore, Esposito et al retrospectively evaluated long term efficacy of etanercept in PsO patients older than 65 years 70. At week 156, PASI 75 was achieved in 84% of the 61 study subjects.…”

Recommendations for managing a suboptimal response to biologics for moderate-to-severe psoriasis: A Belgian perspective

“…Response to some biologics may be affected by the patient's body weight, with optimal responses to fixed doses being less frequent in heavier patients (25)(26)(27).…”

“…Although etanercept and adalimumab are administered in a fixed-dose regimen, optimal responses to fixed doses are less frequent in heavier patients (25,26). It is recommended that patients on ustekinumab receive a 90 mg instead of 45 mg dose when body weight exceeds 100 kg; 45 mg has also been shown to be efficacious, but 90 mg resulted in greater efficacy (49).…”

Differential management of mild-to-severe psoriasis with biologic drugs: An Italian Delphi consensus expert panel

“…The incidence of serious infections in infliximaband adalimumab-treated patients older than 65 years has been shown to be greater than in those under 65 years of age (7). In ustekinumab and etanercept phase III studies, no overall differences in adverse events have been observed in elderly patients compared with younger patients (8)(9)(10)(11)(12)(13); however, caution should always be exercised when treating the elderly population, paying a special attention to occurrence of infections. Based on the existing evidence, the Delphi participants agreed on no preference for use of specific biologics in elderly patients.…”