Biologic Efficacy in Psoriasis Comparable Among Older, Younger Patient Cohorts

The efficacy of biologic treatments for psoriasis is comparable between older and younger patients, new findings suggest, although drug survival rates among older patients are lower in the treatment period.1

These findings were the results of new research conducted by a team of investigators led by Tereza Sobotkova, from the Department of Dermatovenerology at Charles University’s Bulovka University Hospital in Prague. Sobotkova et al. highlighted the fact that despite the increasing number of older individuals treated with biologics for psoriasis, there had previously been limited data availability on them, given their underrepresentation in clinical trials.

“This study compared a large cohort of older adults during the first year of biological treatment for psoriasis to younger adult patients with similar characteristics to advance knowledge about the biologic treatment of psoriasis in older patients,” Sobotkova and colleagues wrote.1

The investigators focused their research on assessing biologic therapies' effectiveness, safety, and treatment durability (drug survival) among older adults with psoriasis—specifically, individuals aged 65 years or older at the initiation of a new biologic drug. The use of this medication was evaluated whether as a first-line therapy or after a switch from another biologic option.

The investigative team's real-world analysis evaluated data from the Czech National Registry BIOREP, a prospective registry that contained data from 2015 - 2023 on patients who had been to 9 major dermatology centers. For the purposes of a comparative analysis, they matched each older subject with 2 younger control patients in the age range of 18 - 63 years.

The team determined the controls based on who was of the same sex, used the same biologic therapy, and who was shown to be treatment-naïve or experienced. Their matching also accounted for the treatment center and period of treatment to diminish the potential for variability in adverse event (AE) reporting.

At the point of baseline, the investigators gathered data such as personal health information and demographics. Some of the health characteristics they recorded included disease duration, body mass index (BMI), the existence of psoriatic arthritis, comorbid conditions, psoriasis severity measured via Psoriasis Area and Severity Index (PASI) scores, and previously-used therapies such as conventional systemics, biologics, or phototherapy.

At baseline, PASI scores were noted and then they were subsequently evaluated among study participants at the 14 (±2), 26 (±4), and 52-week (±4) marks. Response to therapeutics was determined by the research team through PASI 75, PASI 90, and PASI 100 scores recorded at each of these points in time. They based the assessments of safety on AEs documented during routine visits by patients throughout the study period.

There were 265 older adult subjects and 530 matched younger controls involved in the study. Overall, the PASI ≤ 2 achievement rates among these participants were found by the investigative team to be comparable between age groups at the 14-week mark (67% in older versus 63% in younger), the 26-week mark (71% versus 76%), and the 52-week mark (72% versus 76%).1

In their assessment of AEs, such events were noted by the team within the first year of treatment with biologics in 41% of the older cohort and 40% of the younger cohort.1 When they evaluated the 2 arms of the study for serious adverse events (SAEs), such events were seen in 5% of the older arm of the study and 3% of the younger arm.

Drug survival, defined as the proportion of individuals who stuck with treatment following a single year, was shown to be 88% in the older cohort and 96% in the younger cohort.1 The greater rate of drug survival among younger patients was especially notable among those treated with adalimumab, given that rates of drug survival were found to be 81% in older subjects and 99% in younger subjects.

“In conclusion, our study confirmed the similar efficacy and overall safety of biological treatment for psoriasis in older and younger adult patients,” they wrote.1 “Despite more comorbidities, the incidence of severe AEs did not increase in older patients. However, older patients had a lower survival rate after biologic treatment for psoriasis, particularly in those treated with adalimumab.”

References

1. Sobotkova T, Hugo J, Rob F, et al. Efficacy, Safety, and Drug Survival During the First Year of Biologic Therapy for Psoriasis in Elderly Versus Younger Patients. Int J Dermatol. https://doi.org/10.1111/ijd.17814.

2. EJ Horn, KM Fox, M Lebwohl, et al. “Are Patients With Psoriasis Undertreated? Results of National Psoriasis Foundation Survey,” Journal of the American Academy of Dermatology 57 (2007): 957–962.