Where are the older adults? Age distribution of nail psoriasis randomized clinical trials’ participants: a systematic review

Abstract

Where are the older adults? Age distribution of nail psoriasis randomized clinical trials' participants: a systematic review Dear Editor, Nail involvement is common among psoriasis patients, with an estimated lifetime incidence approaching 90%. 1 Psoriasis has a bimodal age incidence, peaking at 30-39 and 60-69 years. Therefore, nail psoriasis (NP) is an important disease among older adults. 1 It is unknown whether therapeutic safety and efficacy data from NP clinical trials pertain to this population. In this letter, we present a subanalysis of our systematic review on the ethnoracial composition of NP randomized clinical trials (RCTs), 2 characterizing age distribution and participation of older adults in NP RCTs. Using Preferred Reported Items for Systematic review and Meta-analysis (PRISMA) reporting guidelines, we conducted a systematic review (PROSPERO protocol: CRD42020213662) 2 of RCTs examining pharmacologic treatments for NP and/or cutaneous psoriasis/psoriatic arthritis where a number of patients with NP was described. Variations of the terms "psoria-

Nails in older adults

“…Systemic therapies should be considered if NP is severe, involves many fingernails/toenails and with joint involvement [ 57 , 58 ]. Older adults are underrepresented in NP randomized clinical trials, thus recruitment of this population in research studies are needed to establish applicable NP treatment guidelines [ 59 ].…”

Reply to “Where are the older adults? Age distribution of nail psoriasis‐randomized clinical trials' participants: a systematic review” by Ricardo JW et al.

“…4 Ricardo et al analyzed 45 studies on pharmacologic treatments for nail psoriasis in order to characterize age distribution and participation of older adults. 3 The authors reported that 30 studies (66.67%) did not have an upper age limit. However, of these, only eight (26.7%) studies reported a number of participants over 65 years old, accounting for an average participation of 5.8%.…”

“…2 Indeed, comorbidities, polypharmacy, drug interactions, and side effects are more frequent as well as conventional systemic treatments (methotrexate, cyclosporine, and acitretin) are often contraindicated and show a higher risk of adverse events or drug interactions. 2 We have read with great interest the article recently published by Ricardo et al 3 entitled "Where are the older adults? Age distribution of nail psoriasis-randomized clinical trials' participants: a systematic review" presenting a sub-analysis of a systematic review assessing the ethnoracial composition of randomized clinical trials.…”

“…However, of these, only eight (26.7%) studies reported a number of participants over 65 years old, accounting for an average participation of 5.8%. 3 Recently, we performed a thorough review of the literature examining the current data on the safety and efficacy of biologics and small molecules for the treatment of psoriasis in the elderly. 2 A total of 28 studies on the use of biologics and small molecules in elderly psoriatic patients were considered.…”

“…2 A total of 28 studies on the use of biologics and small molecules in elderly psoriatic patients were considered. 2 According to Ricardo et al, 3 elderly patients are often unconsidered in clinical trials, and population-specific data are required to make evidence-based therapeutic recommendations.…”