Efficacy and Safety of Systemic Treatments for Psoriasis in Elderly Patients

Piaserico, Stefano; Conti, Andrea; Console, Francesco Lo; Simone, Clara De; Prestinari, F.; Mazzotta, Annamaria; Gualdi, Giulio; Guarneri, Claudio; Borsari, Stefania; Cassano, Nicoletta

doi:10.2340/00015555-1719

Cited by 76 publications

(88 citation statements)

References 13 publications

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“…In 2016, a systemic review of the effectiveness of acitretin in adult patients with chronic plaque type psoriasis in daily practice showed that only one retrospective dataset for acitretin treatment ( n = 62) was available . In it, 27% of the patients achieved PASI 75 at week 12; that was similar to the findings of a study by Chiricozzi et al .…”

Section: Discussionsupporting

confidence: 52%

“…The demographic data, patients’ characteristics, clinical courses, duration of treatment, initial and cumulative dosages of acitretin, side effects, reasons for treatment discontinuation, and relevant laboratory investigations were recorded. Patients aged 65 years or older were defined as elderly patients with psoriasis . Metabolic syndrome was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria .…”

Section: Methodsmentioning

confidence: 99%

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Long‐term safety and drug survival of acitretin in psoriasis: a retrospective observational study

et al. 2018

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Background This retrospective observational study aimed to investigate the long‐term safety, drug survival, and factors associated with the survival of acitretin in a real‐world setting. Methods Data of adult patients with psoriasis who attended Siriraj Hospital between 2012 and 2017 and were treated with acitretin were reviewed. Demographic data and clinical courses were recorded. The Kaplan–Meier curve and Cox regression were used to calculate drug survival and the factors associated with drug survival, respectively. Results Of 104 patients, 56 and 48 were male and female, respectively, with a mean treatment duration of 3.2 years. The mean cumulative dose per patient was 19.28 ± 7.84 mg/day. Acitretin was administered to 73, 39, 24, and six patients for more than 1, 3, 5, and 10 years, respectively. Most side effects were mild and tolerable; only nine patients withdrew acitretin due to side effects. No patients developed clinical features of cirrhosis or uncontrolled hyperlipidemia. The drug survival rates were 79%, 69.5%, 61.2%, 57.6%, and 53.5% at 1, 2, 3, 4, and 5 years, respectively, higher than those of previous studies. Patients without obesity, metabolic syndrome, and dyslipidemia did not have a significantly longer acitretin survival compared to patients with these comorbidities. Conclusions Long‐term, low‐dose acitretin in patients with psoriasis is unlikely to cause significant liver or lipid problems. In countries with difficulty accessing biological agents for psoriasis, acitretin may have a high drug survival rate due to its long‐term safety. This study has several limitations: its retrospective nature, single‐center study design, and small sample size.

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Section: Discussionsupporting

confidence: 52%

Section: Methodsmentioning

confidence: 99%

Long‐term safety and drug survival of acitretin in psoriasis: a retrospective observational study

et al. 2018

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“…The elderly population is generally excluded from randomized clinical trials. However, some studies have addressed the use of biologics in the elderly including adalimumab, ustekinumab and etanercept . We agreed that for appropriately screened and monitored elderly patients who require a systemic treatment, all therapies can be safely used.…”

Section: Resultsmentioning

confidence: 96%

Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis

Gisondi

Altomare

Ayala

et al. 2017

Acad Dermatol Venereol

155

159

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Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.

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“…One of the most common concerns when treating geriatric patients with psoriasis is the use of immunosuppressive agents in the elderly with comorbidity, which can lead to a high risk of infection and to poor prognosis …”

Section: Discussionmentioning

confidence: 99%

Psoriasis in elderly patients in the Côte d'Ivoire: socio‐demographic, clinical, and therapeutic aspects, and follow‐up

et al. 2015

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Efficacy and Safety of Systemic Treatments for Psoriasis in Elderly Patients

Cited by 76 publications

References 13 publications

Long‐term safety and drug survival of acitretin in psoriasis: a retrospective observational study

Long‐term safety and drug survival of acitretin in psoriasis: a retrospective observational study

Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis

Psoriasis in elderly patients in the Côte d'Ivoire: socio‐demographic, clinical, and therapeutic aspects, and follow‐up

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