Effectiveness and Safety of Systemic Therapy for Psoriasis i
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Treating older adults with psoriasis can be challenging owing to comorbidities, concomitant medication use, and consequent safety risks. Although many studies focus on the effectiveness and safety of systemic antipsoriatic therapies in the general population, their effectiveness in older adults with psoriasis has not been systematically assessed.

To evaluate the effectiveness and safety of systemic antipsoriatic therapies in patients 65 years or older a systematic literature search was conducted in Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL). No date limit was used. Randomized clinical trials, cohort studies, large case series, and meta-analyses assessing efficacy (or effectiveness) and/or safety of systemic antipsoriatic therapies in patients 65 years or older were included.

The initial search yielded 11 096 results, of which 31 unique articles with 39 561 patients were included in analysis. Overall, limited data were available per systemic agent, and overall quality of the included studies on conventional systemic therapies was low. At the end of the induction phase (12-16 weeks after start of treatment), a reduction of 75% in Psoriasis Area and Severity Index was achieved in: -49% of 74 methotrexate sodium users
-46% to 52.6% of 178 cyclosporin users
-27% to 47.8% of 108 acitretin users
-15.6% to 64% of 256 etanercept users
-66.7% to 93% of 43 infliximab users
-60.7% to 65% of 100 adalimumab users
-56.5% of 46 ustekinumab users
-86.4% of 67 secukinumab users

Effectiveness of acitretin, etanercept, adalimumab, and secukinumab appeared not to be associated with age; studies regarding other systemic antipsoriatic therapies did not provide age group comparisons. Older age was significantly associated with renal function deterioration in cyclosporin users and with lymphopenia in fumaric acid esters users. Infections were the most frequently reported adverse event in patients 65 years or older using biologics, but no significant association with age was found.

On the basis of limited available evidence, age alone should not be a limiting factor in psoriasis management. Awareness of comorbidities and concomitant medication use is very important, as well as appropriate dosing and frequent laboratory and clinical monitoring. More real-world evidence and (sub)analyses of prospective cohort studies on the effectiveness and safety of systemic therapies in older adults are critical to optimize personalized, effective, and safe antipsoriatic management in this growing patient group.

Source: https://jamanetwork.com/journals/jamadermatology/fullarticle/2769110
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