Biologic and Conventional Systemic Therapies Show Similar Safety and Efficacy in Elderly and Adult Patients With Moderate to Severe Psoriasis
August 2015 | Volume 14 | Issue 8 | Original Article | 846 | Copyright © 2015
Caren Garber BA,a,b Natalia Plotnikova MD,a Shiu-chung Au MD,a Eric P Sorensen BS,a Alice Gottlieb MD PhDa,b
aDepartment of Dermatology, Tufts Medical Center, Boston, MA
bTufts University School of Medicine, Boston, MA
BACKGROUND/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 nonelderly cohorts. Within the elderly population, biologics may be a safer option than conventional systemic agents.
J Drugs Dermatol. 2015;14(8):846-852.
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The elderly represent a significant proportion of psoriasis vulgaris patients due to the chronic nature of the disease and its bimodal incidence with a second peak near the seventh decade of life.1 An estimated 3-10% of psoriatic patients are currently ≥ 70 years old.2,3 However, by the year 2050, the population aged 65 and older is projected to nearly double.4 In spite of this, limited data are published regarding the features and management of geriatric psoriasis.2
Increased medical comorbidities, concerns about polypharmacy and interactions, altered pharmacokinetics, and the lack of supporting data make the use of systemic medications in the elderly especially challenging.2,3 As a result, physicians tend to overprescribe topical medications in this population even when systemic agents are indicated, leading to inadequate management of a large proportion of their geriatric psoriasis patients.5 The purpose of this study is to compare efficacy, safety, and prescribing patterns of conventional systemic and biologic medications in the elderly to that in adults in order to guide physicians in the treatment of geriatric psoriasis.
In this retrospective observational cohort study, analysis was performed on a database of psoriasis patient visits to the Department of Dermatology at Tufts Medical Center, a tertiary care center in the Northeastern United States. The dermatology clinic has approximately 19,000 dermatology visits and 3,600 new patient encounters annually6 and it serves as a psoriasis referral center for the greater community.