Effectiveness and Safety of Anti-interleukin-17 Therapies in Elderly Patients with Psoriasis

Phan, C.; Bénéton, N.; Delaunay, J.; Réguiai, Z.; Boulard, C.; Fougerousse, Anne‐Claire; Cinotti, Élisa; Romanelli, Marco; Méry‐Bossard, L.; Thomas‐Beaulieu, D.; Parier, J.; Maccari, F.; Perrot, Jean‐Luc; Ruer‐Mulard, M.; Bastien, Marie; Bégon, É.; Samimi, Mahtab; Jacobzone, C.; Quiles‐Tsimaratos, N.; Descamps, V.; Steff, M.; Bilan, P.; Vermersch‐Langlin, A.; Kemula, M.; Amazan, E.; Kupfer‐Bessaguet, I.; Cottencin, A.-C.; Prignano, Francesca; Livideanu, Bulai; Gottlieb, J.; Beauchet, Alain; Mahé, E.

doi:10.2340/00015555-3678

Cited by 25 publications

(19 citation statements)

References 19 publications

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“…More than 50% of the patients in our series had more than three comorbidities. The frequency of comorbidities in people aged 65+ years was very similar to that reported in the study by Phan et al [36]. It is important to note the more frequent presence of arthritis in older patients in our series compared with what has previously been published [4,36].…”

Section: Discussionsupporting

confidence: 90%

“…We are aware of only one study of people over 65 years of age in which survival curves indicated survival rates in the first year around of 80% for secukinumab, ixekizumab, and brodalumab [36], similar to our results. The differences between our patients were minimal in secukinumab and in ixekizumab, but the number of patients in both series was too low to permit statistical comparison.…”

Section: Discussionsupporting

confidence: 89%

“…We did not find such differences in our series, which may be attributed to the fact that our study considered only elderly patients undergoing biological treatment [3]. CVR factors such as obesity, hypertension, dyslipidaemia, diabetes mellitus and metabolic syndrome were more prevalent in patients with psoriasis [36], which is an independent risk factor for the appearance of these comorbidities [10,23,[37][38][39][40][41]. More than 50% of the patients in our series had more than three comorbidities.…”

Section: Discussionmentioning

confidence: 76%

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Use of Biological Treatments in Elderly Patients with Skin Psoriasis in the Real World

Osuna

García

Martín

et al. 2021

Life

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Biological drugs have prompted a revolution in the treatment of patients with psoriasis because of their favourable efficacy/risk profile. The aims of our study are to determine whether there is any difference in the pattern of use of biological treatments for older (65+ years) and younger patients diagnosed with plaque psoriasis by the Dermatology Service of the Hospital Universitario de Asturias (HUCA), to understand the survival of these drugs, and to identify the factors that predict the discontinuation of treatments. We report a retrospective observational hospital-based study of 300 patients registered at HUCA’s Dermatology Service who were receiving one of the following biological treatments for psoriasis on 30 November 2020: adalimumab, ustekinumab, secukinumab, or ixekizumab. The age groups were compared using Student’s t-test for quantitative variables and the chi-squared test for qualitative variables. We used the Kaplan–Meier estimator to estimate the survival function and the log-rank test to measure differences. No statistically significant differences in the frequency of use were noted between the younger and older groups, for any of the drugs studied. Survival on a drug regime, globally and individually, was similar in the two age groups. Factors predicting lower overall survival were being female, obesity, and having undergone previous biological treatment. The first three factors were influential in the under-65-year-old group, while arthritis was a significant factor for the older group.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 76%

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Use of Biological Treatments in Elderly Patients with Skin Psoriasis in the Real World

Osuna

García

Martín

et al. 2021

Life

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“…Regarding anti‐IL‐17 inhibitors, a recent study including 114 elderly patients showed that these drugs were an effective and safe therapeutic option for patients with psoriasis aged ≥ 65 years, with low rates of only mild AEs; however, the discontinuation rate was 28.9%, mostly related to psoriasis relapses 30 . A post hoc analysis of three phase III secukinumab trials (ERASURE, FIXTURE and CLEAR) showed comparable efficacy profiles between elderly and younger patients; however, the rates of serious AEs and discontinuation were higher in older participants 31 .…”

Section: Discussionmentioning

confidence: 99%

Anti‐interleukin‐23 for psoriasis in elderly patients: guselkumab, risankizumab and tildrakizumab in real‐world practice

Ruggiero

Fabbrocini

Cinelli

et al. 2021

Clin Experimental Derm

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Summary Background Elderly patients (aged ≥ 65 years) represent an increasing proportion of patients with psoriasis and 15% of these have moderate to severe disease. Biologics are being used frequently in this group of patients even though safety and efficacy data are limited. In addition, owing to anti‐interleukin (IL)‐23 therapies being a relatively recent option, no data have been reported about their use in elderly patients with psoriasis. Aim To evaluate and compare the safety and efficacy of guselkumab, risankizumab and tildrakizumab in real‐world practice in elderly patients. Methods This was a single‐centre retrospective study that enrolled patients aged ≥ 65 years with moderate to severe plaque psoriasis, treated with guselkumab, risankizumab or tildrakizumab. The length of the study for each group depended on the drug (44 weeks for risankisumab, 40 weeks for guselkumab and 28 weeks for tildrakizumab, owing to its more recent availability in Italy). Results In total, 34 patients were enrolled (n = 20 on guselkumab; n = 8 on risankizumab; n = 6 on tildrakizumab). At Week 4, 29.4% reached 90% improvement in Psoriasis Area and Severity Index (PASI90) and 8.8% reached 100% improvement in PASI (PASI100); at Week 28, PASI90 and PASI100 was reached by 58.8% and 29.4%, respectively. At the final follow‐up (Week 40 or 44, depending on drug), data were available only for the risankizumab (Week 40) and guselkumab (Week 44) and groups, and showed that 71.4% of patients had reached PASI90 and 53.5% had reached PASI100. Four patients (11.7%) discontinued treatment. No significant differences were found between the three groups. The limitations of the study included its retrospective nature of the study, small sample size, and different numbers of patients and follow‐up duration for the different groups (highest for guselkumab, lowest for tildrakizumab). Conclusion The three anti‐IL‐23 therapies assessed are promising, safe and effective options in elderly patients, and there was no significant difference between them. However, more data are needed to confirm our results and to understand their role in the management of this group of patients.

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“…However, a direct etiologic relationship on a case-by-case basis is difficult to prove, while, in a few of these studies, other confounding factors may exist, such as the use of medications that could (either directly or indirectly) provoke candidiasis development, such as oral steroids, immunomodulatory agents (e.g., methotrexate), and antidepressants [ 33 , 47 , 53 ]. Further, correlations with patients’ demographics cannot be made, since almost all clinical trials do not provide the specific demographic characteristics of those who developed OC; however, a study evaluating elderly patients (above 65 years of age) reported that no significant association between the frequency of adverse events, including OC, and their specific age was observed [ 57 ]. In relationship to diagnostic methodology, the specific work-up used to diagnose OC is not detailed in most clinical trials, which also do not describe the specific site and clinical appearance of lesions.…”

Section: Discussionmentioning

confidence: 99%

Oral Candida Infection in Psoriatic Patients Treated with IL17A Inhibitors: Report of 3 Cases and a Comprehensive Review of the Literature

et al. 2021

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An intact and fully functional immune system plays a crucial role in the prevention of several infectious diseases. Interleukin (IL)17 is significantly involved in oral mucosa immunity against several antigens and microorganisms, including Candida albicans (CA). Herein, we present three cases of oral candidiasis (OC) related to the use of an IL17A inhibitor for psoriasis. Three psoriatic individuals presented for evaluation of widespread symptomatic oral lesions temporally correlated with the onset of IL17A inhibitors (secukinumab in two patients and brodalumab in one patient). Clinical examination revealed either partially removable white plaques in an erythematous background (case #1) or diffuse erythematous lesions (cases #2 and 3) involving several areas of the oral mucosa. Cytology smear, accompanied by histopathologic examination in case #1, confirmed the clinical impression of OC in all three cases. All patients received antifungal therapy with satisfactory clinical response. No discontinuation of the antipsoriatic regimen was recommended, but all patients were advised to remain under monitoring for possible OC relapses. During the last few years, new systemic biologic agents targeting IL17 have been used for the management of variable immune-mediated diseases. Few clinical trials and scarce case reports have shown that these medications place individuals at high risk of developing candidiasis. We propose that patients treated with these medications should be at close monitoring for the development of OC and, if it occurs, receive appropriate management.

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Effectiveness and Safety of Anti-interleukin-17 Therapies in Elderly Patients with Psoriasis

Cited by 25 publications

References 19 publications

Use of Biological Treatments in Elderly Patients with Skin Psoriasis in the Real World

Use of Biological Treatments in Elderly Patients with Skin Psoriasis in the Real World

Anti‐interleukin‐23 for psoriasis in elderly patients: guselkumab, risankizumab and tildrakizumab in real‐world practice

Oral Candida Infection in Psoriatic Patients Treated with IL17A Inhibitors: Report of 3 Cases and a Comprehensive Review of the Literature

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