Efficacy of biological agents to treat psoriasis varies with age: study

Current management of moderate-to-severe psoriasis does not differentiate between patient age in the selection of the safest or most effective biologic treatments. However, age is thought to have a significant effect on treatment response, leading to the discontinuation of certain types of inhibitors, reveals a recent British study.An analysis of 14,300 patients with moderate to severe psoriasis showed that younger patients (aged 16-to-24) were more likely to discontinue treatment due to ineffectiveness. In individuals over 55, side-effects caused by taking the drug topped the list of reasons for discontinuing treatment.Read: Psoriasis linked to ultra-processed foodsSpecifically, the 55-to-64 age group was more likely to discontinue TNF and IL-12/IL-23 inhibitors due to adverse effects. In the 65-74 age group, IL-23 inhibitors were best tolerated, while anti-TNF, IL-12/IL-23 and IL-17 were more frequently discontinued. This greater tolerance of IL-23 inhibitors in the older population is consistent with a previous study of individuals aged over 65, only 11% of whom discontinued IL-23. This treatment was also more effective, with 71% of patients achieving PASI 90 after 44 weeks of treatment.ComorbiditiesIndividuals over 75 years of age were at greater risk of discontinuing the four groups of biological agents under study due to adverse effects. This could be explained by, among other things, longer disease duration, more comorbidities and the increase in psoriatic arthritis with age.“Biological agents have proven effective in elderly people with plaque psoriasis,” the study authors pointed out. However, rigorous monitoring of undesirable side-effects must be implemented to avoid discontinuation of treatment in people over 65,” they warned.Older patients represent a growing proportion of psoriasis sufferers, 15% of whom will develop the moderate-to-severe form of the disease.Higher expectations among youthYounger patients (aged 16-to-24) were more likely to abandon TNF inhibitors than any other group of biological agents. Failure to achieve clear or nearly clear skin may have led to higher discontinuation in younger patients. However, assessment of disease severity with PASI has shown that the efficacy of biological agents varies little with age. The researchers therefore speculate that discontinuation in younger patients is not due to treatment failure, but rather to their higher expectations not being met.To take part in the study, patients had to be aged 16 or over and have been receiving one of the four inhibitor groups (original or bio-similar) for at least six months:Anti-TNF (adalimumab, etanercept, certolizumab, golimumab)Anti-IL-12/IL23 (ustekinumab)Anti-IL-17 (brodalumab, ixekizumab, secukinumab)Anti-IL-23 (guselkumab, risankizumab, tildrakizumab)The results are published in the British Journal of Dermatology.

Efficacy of biological agents to treat psoriasis varies with age: study

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