Biologic and Conventional Systemic Therapies Show Similar Safety and Efficacy in Elderly and Adult Patients With Moderate to Severe Psoriasis.
OBJECTIVE
Despite the aging population, few studies have documented the treatment of geriatric psoriasis. The purpose of this study is to compare the efficacy, safety, and prescribing patterns of biologics and conventional systemic medications in elderly versus adult psoriasis.


METHODS
All patient visits coded for psoriasis or psoriatic arthritis (ICD-9 696.1 or 696.0) at the Tufts Medical Center General Dermatology Clinic from January 1, 2008, to March 1, 2015 were included in this retrospective cohort study. The outcome measure used was the validated simple-measure for assessing psoriasis activity (S-MAPA), the product of the physician's global assessment and the body surface area.


RESULTS
194 patients who underwent 278 treatment courses were included in the study. 48 patients were included in the elderly cohort (≥ 65 years old) and 146 in the adult cohort (18-64 years old). There was no significant difference in S-MAPA improvement at 12 weeks between the two cohorts when treated with biologics (42.92% improvement in adults, 48.77% in elderly; P=0.498) or conventional systemics (43.96% and 51.82%, respectively; P=0.448). Within the elderly cohort, there was no significant difference in efficacy of biologics versus conventional systemics at any time point. Topical prescription rates were significantly higher in the elderly cohort ( P=0.004) while biologic prescription rates were significantly lower ( P=0.014) despite the same baseline S-MAPA in both age groups. For both biologics and conventional systemics, there was no statistically significant intergroup difference in the rate of adverse events ( P=0.322 for biologics; P=0.581 for conventional systemics) or infection ( P=0.753 for biologics; P=0.828 for conventional systemics). Within the elderly cohort, there was a higher rate of adverse events with conventional systemic treatment than with biologic treatment ( P=0.033).


CONCLUSIONS
This study provides preliminary evidence to suggest that biologic and conventional systemic therapies are similarly safe and effective in the elderly and non-elderly cohorts. Within the elderly population, biologics may be a safer option than conventional systemic agents.
Caren
C
Garber
Natalia
N
Plotnikova
Shiu-chung
SC
Au
Eric P
EP
Sorensen
Alice
A
Gottlieb
D017255:Acitretin / Q000627:therapeutic use; D000068879:Adalimumab / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D000068582:Certolizumab Pegol / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011565:Psoriasis / Q000188:drug therapy* / Q000532:radiotherapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014467:Ultraviolet Therapy; D000069549:Ustekinumab / Q000627:therapeutic use; D055815:Young Adult
D000911:Antibodies, Monoclonal; D001688:Biological Products; D003879:Dermatologic Agents; D016572:Cyclosporine; C529000:golimumab; D000069285:Infliximab; D000069549:Ustekinumab; D000068879:Adalimumab; D017255:Acitretin; D000068800:Etanercept; D000068582:Certolizumab Pegol; D008727:Methotrexate