Efficacy and safety of biologics for the treatment of moderate-to-severe psoriasis in older adults: a single-centre Italian experience.

Background: Demographic changes lead to a number of issues regarding the biological treatment of older patients with moderate-to-severe psoriasis.

Objectives: To investigate the efficacy and safety of biologics in older adults, substratifying the population based on age, comorbidities and previous therapies over a longer timespan (> 60 weeks).

Methods: A retrospective, single-centre study was conducted with patients aged ≥ 65 years with moderate-to-severe psoriasis who had been undergoing treatment with biologic drugs for > 60 weeks.

Results: Data for 130 patients aged ≥ 65 years with moderate-to-severe psoriasis undergoing biologic therapy were reviewed: 45 were women and with a mean age of 73.23 years (SD 6.53). The decline in mean Psoriasis Area and Severity Index (PASI), body surface area, Dermatology Life Quality Index and Nail Psoriasis Severity Index values over the 60 weeks of treatment was found to be statistically significant at each interval (P < 0.05). Multivariate statistical analysis showed that nearly all the independent variables considered did not influence the response to therapy in terms of PASI score reduction, except for psoriatic arthritis (P = 0.03). We observed a better response in the youngest-old group (aged 65-74 years), with 73% (59/81 patients) achieving ≥ 75% reduction in PASI (PASI 75) and 72% (58/81 patients) achieving PASI 90 and PASI 100 at the 60th week of treatment. The worst result was obtained in the middle-old group (75-84 years old), with 60.0% (24/40 patients) reaching PASI 75 at the end of follow-up, whereas the oldest-old group (≥ 85 years) had a more mixed performance.

Conclusions: The results obtained seem to indicate greater efficacy of anti-tumour necrosis factor-alpha drugs, followed by the other classes of interleukin inhibitors. These results could provide a starting point for new and larger studies and guidelines for biologic treatment.