Use of Biological Treatments in Elderly Patients with Skin Psoriasis in the Real World

Osuna, Cristina Galache; García, Sebastián Reyes; Martín, Jimena Carrero; Jiménez, V García; López, Francisco Vázquez; Santos‐Juanes, Jorge

doi:10.3390/life11121348

Cited by 7 publications

(9 citation statements)

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“…Drug survival is a widely used measure that combines several aspects of treatment modalities (e.g., effectiveness and safety) [ 17 – 19 ]; however, literature on drug survival in older patients with psoriasis is sparse. We found a comparable overall drug survival between the age groups, before and after correction for confounding factors, as also reported for a period of 2 years by Osuna et al [ 20 ]. The crude and confounder-corrected drug survival with regard to ineffectiveness was lower for patients aged ≥ 65 years.…”

Section: Discussionsupporting

confidence: 90%

“…Furthermore, studies describing drug survival in this population are lacking. Our study is an addition to the current scarce body of evidence in older patients; however, more evidence regarding older patients with psoriasis is being published [ 20 , 36 – 38 ]. A strength of this study is its high external validity, due to its real-world practice nature, and multicenter, prospective design.…”

Section: Discussionmentioning

confidence: 99%

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Drug Survival, Safety, and Effectiveness of Biologics in Older Patients with Psoriasis: A Comparison with Younger Patients—A BioCAPTURE Registry Study

et al. 2022

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Background Psoriasis is a common inflammatory disease in any age group, but also in older patients (≥ 65 years of age). Since older patients are often excluded from clinical trials, limited data specifically on this growing population are available, e.g. regarding the safety and performance of biological treatment. Aims We aimed to give insight into this specific population by comparing the drug survival and safety of biologics in older patients with that in younger patients. Methods In this real-world observational study, data from 3 academic and 15 non-academic centers in The Netherlands were extracted from the prospective BioCAPTURE registry. Biologics included in this study were tumor necrosis factor (TNF)-α, interleukin (IL)-17, IL-12/23, and IL-23 inhibitors. Patients were divided into two age groups: ≥ 65 years and < 65 years. The Charlson Comorbidity Index (CCI) was used to measure comorbid disease status, and all adverse events (AEs) that led to treatment discontinuation were classified according to the Medical Dictionary for Regulatory Activities (MedDRA) classification. All AEs that led to treatment discontinuation were studied to check whether they could be classified as serious AEs (SAEs). Kaplan-Meier survival curves for overall 5-year drug survival and split according to reasons of discontinuation (ineffectiveness or AEs) were constructed. Cox regression models were used to correct for possible confounders and to investigate associations with drug survival in both age groups separately. Psoriasis Area and Severity Index (PASI) scores during the first 2 years of treatment and at the time of treatment discontinuation were assessed and compared between age groups. Results A total of 890 patients were included, of whom 102 (11.4%) were aged ≥ 65 years. Body mass index, sex, and distribution of biologic classes (e.g. TNFα, IL12/23) were not significantly different between the two age groups. A significantly higher CCI score was found in older patients, indicative of more comorbidity (p < 0.001). The 5-year ineffectivenessrelated drug survival was lower for older patients (44.5% vs. 60.5%; p = 0.006), and the 5-year overall (≥ 65 years: 32.4% vs. < 65 years: 42.1%; p = 0.144) and AE-related (≥ 65 years: 82.1% vs. < 65 years: 79.5%; p = 0.913) drug survival was comparable between age groups. Of all AEs (n = 155) that led to discontinuation, 16 (10.3%) were reported as SAEs but these only occurred in younger patients. After correcting for confounders, the same trends were observed in the drug survival outcomes. Linear regression analyses on PASI scores showed no statistical differences at 6, 12, 18, and 24 months of treatment between age groups. Conclusions This study in a substantial, well-defined, prospective cohort provides further support that the use of biologics in older patients seems well-tolerated and effective. Biologic discontinuation due to AEs did not occur more frequently in older patients. Older patients discontinued biologic treatment more often due to ineffectiveness, although no clear dif...

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Drug Survival, Safety, and Effectiveness of Biologics in Older Patients with Psoriasis: A Comparison with Younger Patients—A BioCAPTURE Registry Study

et al. 2022

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“…Authors also investigated drug survival, and they found that it did not differ among the three studied drugs. These data are also confirmed by Osuna et al The authors compared drug survival in elderly and younger patients and did not find differences related to the age of the patients [ 58 ].…”

Section: Therapeutic Management Of Elderly Patients With Moderate-to-...supporting

confidence: 73%

“…They include etanercept, adalimumab, infliximab, and certolizumab pegol either as originator or biosimilar drugs, when available. Generally, a similar efficacy in elderly patients undergoing anti-TNF has been reported so far when compared with younger patients [ 55 , 56 , 57 , 58 , 59 ], but a few studies show a lower response rate in elderly patients that were treated for other diseases than psoriasis [ 60 ]. A previous retrospective study positively evaluated the long-term efficacy and safety profile of etanercept and adalimumab in the treatment of elderly patients affected by plaque-type psoriasis and psoriatic arthritis [ 61 ].…”

Section: Therapeutic Management Of Elderly Patients With Moderate-to-...mentioning

confidence: 69%

Therapy of PsO in Special Subsets of Patients

et al. 2022

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Psoriasis is a chronic, inflammatory skin disease that may occur at any age, with a bimodal peak of incidence around the age of 16–20 years of age (early onset) and 57–60 years (late-onset). It is estimated that roughly 70% of patients develop the disease before the age of 40, which coincides with the reproductive years. Moreover, psoriasis is a chronic disease, meaning that, with increased life-duration expectancy, the number of patients affected with psoriasis aged over 65 years is going to increase and represent a big therapeutic challenge. Actually, no specific drug recommendation is available, based only on the age of the patients, while therapeutic prescription should take into account that elderly patients have more comorbidities than younger patients, with polypharmacy and an increased risk of drug interactions. Women with psoriasis are more likely to report a worse influence of the disease on their quality of life, and they are more susceptible to the development of depression. Furthermore, pregnancy and lactation represent a major contraindication to several systemic agents, and only a few studies exist providing the safety of certain drugs during these periods of life of a woman, such as certolizumab pegol. In this paper, we discuss systemic therapeutic strategies, including conventional and biological therapies, in a special subset of patients affected with moderate-to-severe psoriasis focusing on elderly patients and on female patients in fertile age, pregnancy, and lactation.

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“…4 For these reasons, elderly patients with moderate-to-severe psoriasis are often undertreated. [2][3][4][5] Few data are available on the use of interleukin (IL) inhibitors in the elderly, as they are often underrepresented in clinical trials. [3][4][5] This study aimed to evaluate the effectiveness and safety of anti-IL-23 and anti-IL-17 biologics for psoriasis in over-65 patients.We collected data from two Italian hospitals' database records, including patients ≥65 years old receiving an anti-IL-23 or anti-IL-17 agent approved for psoriasis for at least 16 weeks.…”

mentioning

confidence: 99%

Effectiveness and safety of anti‐IL‐23 and anti‐IL‐17 biological therapies for psoriasis in elderly patients: Real‐world experience from two Italian hospitals

Fiorillo

Ibba

Gargiulo

et al. 2023

Acad Dermatol Venereol

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Dear Editor, Psoriasis is a chronic inflammatory disease affecting 2%-4% of the general population worldwide. [1][2][3][4][5] Due to the global increase in life expectancy, older patients with psoriasis constitute a growing group. 2,5 Conventional systemic drugs tend to be avoided in this subpopulation, due to the higher prevalence of comorbidities and drug interactions, whereas recurrent visits for phototherapy may not be suitable for patients with limited mobility or supported by caregivers. 4 For these reasons, elderly patients with moderate-to-severe psoriasis are often undertreated. [2][3][4][5] Few data are available on the use of interleukin (IL) inhibitors in the elderly, as they are often underrepresented in clinical trials. [3][4][5] This study aimed to evaluate the effectiveness and safety of anti-IL-23 and anti-IL-17 biologics for psoriasis in over-65 patients.We collected data from two Italian hospitals' database records, including patients ≥65 years old receiving an anti-IL-23 or anti-IL-17 agent approved for psoriasis for at least 16 weeks. Eligibility for biological therapy was evaluated by using the Italian adaptation of EuroGuiDerm guideline. 6 Patients with a cancer diagnosis within the previous 5 years were started on biologics because they had failed other treatments, after a discussion with the oncologist. We used Psoriasis Area and Severity Index (PASI) to assess severity at each visit. Effectiveness was evaluated by registering the percentages of patients that achieved an improvement of 75%, 90% and 100% in PASI (PASI75, PASI90 and PASI100, respectively) and that reached PASI ≤2. Safety was assessed by evaluating the rates of treatment discontinuation and the occurrence of adverse events (AEs) at each timepoint. Multivariate logistic regression was performed to identify predictors of response to different variables. A p-value of <0.05 was considered statistically significant.This study included 205 patients, with a mean age of 72.20 years (Standard Deviation [SD] 6.88). Of note, the patients ≥75 years old were 66 (32.20%). The characteristics of our population are summarized in Table 1. All patients completed 16 weeks of biological treatment, whereas 148 (72.20%) reached 52 weeks and 96 (46.83%) 104 weeks. The results concerning the effectiveness profile and multivariate analysis are shown in Figure 1. PASI 90 and 100 were achieved by 116 (78.38%) and 88 (59.46%) patients at week 52 and by 73 (76.04%) and 55 (57.29%) patients at week 104, respectively. At week 16, a higher PASI 75 response was observed in the bio-naïve subgroup (odds ratio [OR]: 3.13, 95% confidence interval [CI]: 1.19-8.22, p = 0.021) and a lower PASI90 response in patients with involvement of difficult-to-treat areas (OR: 0.28, 95% CI 0.10-0.74, p = 0.011). At week 104, we found that PASI90 response was significantly lower in the obese subgroup (OR: 0.15, 95% CI 0.02-0.94, p = 0.043). Regarding safety, biological treatment

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Use of Biological Treatments in Elderly Patients with Skin Psoriasis in the Real World

Cited by 7 publications

References 50 publications

Drug Survival, Safety, and Effectiveness of Biologics in Older Patients with Psoriasis: A Comparison with Younger Patients—A BioCAPTURE Registry Study

Drug Survival, Safety, and Effectiveness of Biologics in Older Patients with Psoriasis: A Comparison with Younger Patients—A BioCAPTURE Registry Study

Therapy of PsO in Special Subsets of Patients

Effectiveness and safety of anti‐IL‐23 and anti‐IL‐17 biological therapies for psoriasis in elderly patients: Real‐world experience from two Italian hospitals

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