Elderly psoriatic patients under biological therapies: an Italian experience

Ricceri, Federica; Bardazzi, Federico; Chiricozzi, Andrea; Dapavo, Paolo; Ferrara, Francesca; Mugheddu, Cristina; Romanelli, Marco; Rongioletti, Franco; Prignano, Francesca

doi:10.1111/jdv.15139

Cited by 33 publications

(26 citation statements)

References 13 publications

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“…18 Thirteen studies were excluded because they did not have sufficient data for the control population. [19][20][21][22][23][24][25][26][27][28][29][30][31] Thus, our final analysis included 14 unique studies. [7][8][9][32][33][34][35][36][37][38][39][40][41][42] Of these, 3 studies had only the abstract available for review, but sufficient detailed information could be extracted to allow for inclusion.…”

Section: Literature Searchmentioning

confidence: 99%

Safety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

Borren

Ananthakrishnan

2019

Clinical Gastroenterology and Hepatology

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e108. Learning Objective-Upon completion of this activity, successful learners will be able to define the diagnosis, natural history, and treatment of IBD in older individuals. BACKGROUND & AIMS: Management of immune-mediated inflammatory diseases often requires lifelong immunosuppression. Increasing numbers of older patients have inflammatory diseases and are particularly vulnerable to risks of immune suppressive therapies-particularly infections and malignancies. METHODS: We systematically searched PubMed/Medline and Embase to identify eligible studies that examined the safety of biologic therapies in older patients with immune-mediated inflammatory diseases (inflammatory bowel disease, rheumatoid arthritis, psoriasis). Included studies provided information on patients who began receiving therapy with a biologic agent when they were older than 60 years and a control population (either younger users of biologics or older patients who did not use biologics). Information of on overall pooled rates of infections, malignancy, and mortality were extracted. A DerSimonian and Laird random effects model was used to calculate pooled odds ratios (ORs) and 95% CIs. RESULTS: Our meta-analysis included 14 unique studies that comprised 4719 older users of biologics, 13,305 younger users of biologics, and 3961 older patients who did not use biologics. The pooled prevalence of infections in older and younger users of biologics was 13% and 6% respectively, yielding a pooled random effects odds ratio of 2.28 (95% CI, 1.57-3.31). Older age was associated with a significant increase in risk of malignancy (OR, 3.07; 95% CI, 1.98-4.62) compared to younger age. Older users of biologics had a 3-fold increase in risk of infection compared to patients who did not use biologics (OR, 3.60; 95% CI, 1.62-8.01), but there were no significant differences in odds of malignancy (0.54, 95% CI, 0.28-1.05) or death (OR, 1.52; 95% CI, 0.44-5.28) compared to older patients who did not use biologics. CONCLUSION: In a systematic review and meta-analysis of studies on the safety of biologic therapies in older patients with inflammatory diseases, we found that older users of biologic agents have an increased risk of infections compared with younger users or older patients who do not use biologics. Large, prospective cohort studies are needed to examine safety of biologic therapy in older patients with immune-mediated diseases

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Section: Literature Searchmentioning

confidence: 99%

Safety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

Borren

Ananthakrishnan

2019

Clinical Gastroenterology and Hepatology

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“…However, only few studies are available on biologics efficacy and safety for patients ≥ 65 years, who are often excluded from clinical trials. In particular, most studies have focused on the efficacy and safety of tumour necrosis factor (TNF)-a or interleukin (IL)-12/23 inhibitors, [7][8][9][10] while only very limited data about the use of anti-IL17 exist. 11,12 We performed a real-life retrospective observational study on elderly patients with psoriasis to assess the consistency of safety and efficacy data on the use of secukinumab in the older population with a 2-year treatment follow-up period.…”

Section: Introductionmentioning

confidence: 99%

Real‐life efficacy and safety of secukinumab in elderly patients with psoriasis over a 2‐year period

et al. 2020

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Background The prevalence of psoriasis is increasing among older people. Elderly patients with psoriasis represent a challenge for dermatologists owing to multiple comorbidities, polypharmacy and immune senescence, which lead to an increased possibility of adverse events (AEs), drug interactions and susceptibility to cancers and infections. Therefore, conventional systemic therapies are often contraindicated, with biologics appearing as the mainstay for moderate‐to‐severe disease. However, the data on efficacy and safety of biologics in older people are scant. Aim To evaluate the efficacy and safety of secukinumab in elderly patients with psoriasis over a 2‐year period. Methods A real‐life retrospective observational study was performed on patients aged ≥ 65 years with moderate‐to‐severe plaque psoriasis who were treated with secukinumab at the Psoriasis Care Unit of the University of Naples Federico II, Italy from June 2016 to June 2019. Results Mean Psoriasis Area Severity Index (PASI) reduced from 11.4 ± 6.3 at baseline to 2.1 ± 1.7 at week 24 and 1.7 ± 1.9 at week 96 (P < 0.001 for all follow‐up visits), with a final mean PASI reduction of 85.1%. A similar trend was noted for body surface area (BSA), with baseline value of 27.5 ± 15.7 decreasing to 6.8 ± 5.0 at week 24, and to 3.3 ± 2.5 at week 96 (P < 0.001 at all follow‐up visits), with a final mean BSA score reduction of 88.0%. Registered AEs did not lead to secukinumab discontinuation, except in one patient (3.4%). Conclusion Secukinumab seems to be a safe and effective treatment for elderly patients with psoriasis, who frequently have multiple comorbidities, polypharmacy and multiple failures with previous systemic treatments including biologics.

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“…[ 11 ]. This could be explained by the fact that limited data are available in the literature regarding the safety of biologics in elderly psoriatic patients [ 20 – 23 ]. Moreover, aged patients are largely underrepresented in the clinical trials [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Patients’ demographic and socioeconomic characteristics influence the therapeutic decision-making process in psoriasis

et al. 2020

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Elderly psoriatic patients under biological therapies: an Italian experience

Cited by 33 publications

References 13 publications

Safety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

Safety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

Real‐life efficacy and safety of secukinumab in elderly patients with psoriasis over a 2‐year period

Patients’ demographic and socioeconomic characteristics influence the therapeutic decision-making process in psoriasis

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