Psoriasis in the elderly: From the Medical Board of the National Psoriasis Foundation

Grozdev, Ivan; Voorhees, Abby S. Van; Gottlieb, Alice B.; Hsu, Sylvia; Lebwohl, Mark; Bebo, Bruce F.; Korman, Neil J.

doi:10.1016/j.jaad.2010.05.014

Cited by 66 publications

(49 citation statements)

References 51 publications

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“…Cyclosporine also can increase blood pressure, which is carefully monitored for the side effect of hypertension at each clinic visit. Cyclosporine cannot be used in patients with abnormal baseline serum creatinine and glomerular filtration rate and is used with caution in the elderly [20]. …”

Section: Resultsmentioning

confidence: 99%

“…A major concern for possible harm of methotrexate is to the hepatic system, as methotrexate has been implicated in hepatic fibrosis and cirrhosis. Elderly patients are at increased risk for hepatotoxicity because of an increased tendency for elevated triglycerides, elevated liver function tests, and obesity that are often found in the aging population and are associated with methotrexate-related hepatic fibrosis [20]. A liver biopsy is required with long-term use of methotrexate, a risk for the elderly that may outweigh the benefits of preventing liver damage.…”

Section: Resultsmentioning

confidence: 99%

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The Safety of Systemic Treatments That Can Be Used for Geriatric Psoriasis Patients: A Review

Wong

Koo

2012

Dermatology Research and Practice

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Background. Patients with moderate-to-severe psoriasis are often treated with systemic immunosuppressant agents that decrease immune system function. For the elderly, these medications are often problematic due to their already immunosuppressed state and comorbidities. However, there are few studies examining the effects of these medications on the elderly age group. Therefore, there is often discomfort among dermatologists treating elderly patients with psoriasis in utilizing systemic agents, frequently resulting in inadequate treatment. Objective. We review the safety profiles of systemic treatments often used to treat psoriasis and their possible adverse risks to the geriatric population. Methods. We conducted a search of PubMed's Medline database of articles published from 2000 to 2011, which resulted in 14 articles. Conclusion. Treating geriatric patients with moderate-to-severe psoriasis remains a challenge due to immunosenescence and comorbidities. More studies focusing on psoriasis treatment safety in the geriatric population are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The Safety of Systemic Treatments That Can Be Used for Geriatric Psoriasis Patients: A Review

Wong

Koo

2012

Dermatology Research and Practice

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“…Associations have been made between psoriasis and metabolic syndrome, cardiovascular diseases, malignancy and psoriatic arthritis. Itch is the most common symptom in elderly psoriatic patients [74]. A study done in South Korea in patients with adult-onset psoriasis (aged 60 years and older) found that 75 % of patients suffered from chronic itch and 35 % suffered from moderate to severe itch that interrupted normal daily activities [73].…”

Section: Cutaneous Conditionsmentioning

confidence: 99%

Chronic Pruritus in the Elderly: Pathophysiology, Diagnosis and Management

2015

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Chronic itch in the elderly is a common problem, with a significant impact on quality of life and sleep in elderly patients. Chronic itch may be attributable to several causes, including dry skin, immunosenescence and neural degeneration. Itch may also be caused by skin diseases, such as seborrhoeic dermatitis and stasis dermatitis; systemic conditions, such as end-stage renal disease and diabetes; and psychogenic conditions, such as depression and anxiety. The use of polypharmacy may also cause itch, with or without a rash. Specifically, thiazides and calcium channel blockers have been known to cause itch in elderly patients. Management should be tailored according to the underlying dermatological or systemic aetiology of itch. Topical treatment is the mainstay of therapy, providing special emphasis on skin hydration and barrier repair. In addition, topical and oral medications that target the nervous system and reduce neuronal hypersensitization, such as gabapentin and selective antidepressants, have a role in treating patients with severe chronic itch. Furthermore, management must account for changes in metabolism and pharmacokinetics of drugs in the aging population in order to prevent the occurrence of adverse effects.

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“…10 Lack of data on the treatment of psoriasis in the elderly has been identified as a major research gap, 11 especially because they are often underrepresented in clinical trials and may have unique treatment concerns. 10,12 To address this gap, we examined national claims data for Medicare patients with psoriasis who were initiating biologics to investigate adherence, discontinuation, switching, and restarting of biologic treatment.…”

mentioning

confidence: 99%

Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population

Doshi

Takeshita

Pinto

et al. 2016

Journal of the American Academy of Dermatology

110

107

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Background Studies indicate adherence to biologics among patients with psoriasis is low, yet little is known about their use in the Medicare population. Objective We sought to investigate real-world utilization patterns in a national sample of Medicare beneficiaries with psoriasis initiating infliximab, etanercept, adalimumab, or ustekinumab. Methods We conducted a retrospective claims analysis using 2009 through 2012 100% Medicare Chronic Condition Data Warehouse Part A, B, and D files, with 12-month follow-up after index prescription. Descriptive and multivariate analyses were used to examine rates of and factors associated with biologic adherence, discontinuation, switching, and restarting. Results We examined 2707 patients initiating adalimumab (40.0%), etanercept (37.9%), infliximab (11.7%), and ustekinumab (10.3%); during 12-month follow-up, 38% were adherent and 46% discontinued treatment, with 8% switching to another biologic and 9% later restarting biologic treatment. Being female and being ineligible for low-income subsidies were associated with increased odds of decreased adherence. Outcomes varied by index biologic. Limitations Patient-reported reasons for nonadherence or gaps in treatment are unavailable in claims data. Conclusion Medicare patients initiating biologics for psoriasis had low adherence and high discontinuation rates. Further investigation into reasons for inconsistent utilization, including exploration of patient and provider decision-making and barriers to more consistent treatment, is needed.

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Psoriasis in the elderly: From the Medical Board of the National Psoriasis Foundation

Cited by 66 publications

References 51 publications

The Safety of Systemic Treatments That Can Be Used for Geriatric Psoriasis Patients: A Review

The Safety of Systemic Treatments That Can Be Used for Geriatric Psoriasis Patients: A Review

Chronic Pruritus in the Elderly: Pathophysiology, Diagnosis and Management

Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population

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