Biologic Treatment in Elderly Patients With Psoriasis: A Systematic Review
With our aging population, an increasing number of psoriasis patients are classified as elderly. However, psoriasis treatment in older adults can be challenging, given an increased number of comorbid conditions and immunosenescence. Biologic agents present a solution to this treatment dilemma becaus...
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Veröffentlicht in: | Journal of Cutaneous Medicine and Surgery 2020-03, Vol.24 (2), p.174-186, Article 1203475419897578 |
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description | With our aging population, an increasing number of psoriasis patients are classified as elderly. However, psoriasis treatment in older adults can be challenging, given an increased number of comorbid conditions and immunosenescence. Biologic agents present a solution to this treatment dilemma because of their high efficacy and favorable tolerability. The objective of this systematic review was to summarize the findings of clinical trial and real-world studies exploring the safety and efficacy of biologic agents in elderly patients with moderate-to-severe psoriasis. We searched MEDLINE, Embase, the Cochrane Library, and clinical trial databases. Studies analyzing biologics for psoriasis were included if elderly patients were the main population of interest or were a separate subgroup in their analysis. Eighteen articles met inclusion criteria after screening. Across all biologic classes, efficacy for biologics between nonelderly adult patient and elderly patients was similar. Adverse events (AEs) and infections occured at a similar frequency between both groups. However, serious AEs were more common in the elderly. The available literature on the safety and efficacy of biologic agents in elderly patients supports the use of these agents in this population. However, serious AEs and discontinuation due to AEs were more common in older patients. As elderly patients have a higher burden of comorbid conditions and an increased baseline vulnerability for AE, physicians should continue to be prudent in screening before initiating biologics and monitor patients more closely as AEs tend to be more severe. |
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However, psoriasis treatment in older adults can be challenging, given an increased number of comorbid conditions and immunosenescence. Biologic agents present a solution to this treatment dilemma because of their high efficacy and favorable tolerability. The objective of this systematic review was to summarize the findings of clinical trial and real-world studies exploring the safety and efficacy of biologic agents in elderly patients with moderate-to-severe psoriasis. We searched MEDLINE, Embase, the Cochrane Library, and clinical trial databases. Studies analyzing biologics for psoriasis were included if elderly patients were the main population of interest or were a separate subgroup in their analysis. Eighteen articles met inclusion criteria after screening. Across all biologic classes, efficacy for biologics between nonelderly adult patient and elderly patients was similar. Adverse events (AEs) and infections occured at a similar frequency between both groups. However, serious AEs were more common in the elderly. The available literature on the safety and efficacy of biologic agents in elderly patients supports the use of these agents in this population. However, serious AEs and discontinuation due to AEs were more common in older patients. As elderly patients have a higher burden of comorbid conditions and an increased baseline vulnerability for AE, physicians should continue to be prudent in screening before initiating biologics and monitor patients more closely as AEs tend to be more severe.</description><identifier>ISSN: 1203-4754</identifier><identifier>EISSN: 1615-7109</identifier><identifier>DOI: 10.1177/1203475419897578</identifier><identifier>PMID: 31950853</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Anti-Inflammatory Agents - therapeutic use ; Antibodies, Monoclonal - therapeutic use ; Biological products ; Clinical trials ; Comorbidity ; Dermatologic Agents - therapeutic use ; Dermatology ; Humans ; Life Sciences & Biomedicine ; Older people ; Psoriasis ; Psoriasis - therapy ; Science & Technology ; Systematic review ; Tumor Necrosis Factor-alpha - antagonists & inhibitors</subject><ispartof>Journal of Cutaneous Medicine and Surgery, 2020-03, Vol.24 (2), p.174-186, Article 1203475419897578</ispartof><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>21</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000507834500001</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c365t-431048f3b17af85292ad5c93ad1bbfcb48464bce9dc8cfe0f86de6b77e19918a3</citedby><cites>FETCH-LOGICAL-c365t-431048f3b17af85292ad5c93ad1bbfcb48464bce9dc8cfe0f86de6b77e19918a3</cites><orcidid>0000-0001-5695-6798 ; 0000-0003-2238-7106 ; 0000-0001-9163-5463</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1203475419897578$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1203475419897578$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,315,782,786,794,21826,27929,27931,27932,28255,43628,43629</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31950853$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sandhu, Vijay Kumari</creatorcontrib><creatorcontrib>Ighani, Arvin</creatorcontrib><creatorcontrib>Fleming, Patrick</creatorcontrib><creatorcontrib>Lynde, Charles W.</creatorcontrib><title>Biologic Treatment in Elderly Patients With Psoriasis: A Systematic Review</title><title>Journal of Cutaneous Medicine and Surgery</title><addtitle>J CUTAN MED SURG</addtitle><addtitle>J Cutan Med Surg</addtitle><description>With our aging population, an increasing number of psoriasis patients are classified as elderly. However, psoriasis treatment in older adults can be challenging, given an increased number of comorbid conditions and immunosenescence. Biologic agents present a solution to this treatment dilemma because of their high efficacy and favorable tolerability. The objective of this systematic review was to summarize the findings of clinical trial and real-world studies exploring the safety and efficacy of biologic agents in elderly patients with moderate-to-severe psoriasis. We searched MEDLINE, Embase, the Cochrane Library, and clinical trial databases. Studies analyzing biologics for psoriasis were included if elderly patients were the main population of interest or were a separate subgroup in their analysis. Eighteen articles met inclusion criteria after screening. Across all biologic classes, efficacy for biologics between nonelderly adult patient and elderly patients was similar. Adverse events (AEs) and infections occured at a similar frequency between both groups. However, serious AEs were more common in the elderly. The available literature on the safety and efficacy of biologic agents in elderly patients supports the use of these agents in this population. However, serious AEs and discontinuation due to AEs were more common in older patients. As elderly patients have a higher burden of comorbid conditions and an increased baseline vulnerability for AE, physicians should continue to be prudent in screening before initiating biologics and monitor patients more closely as AEs tend to be more severe.</description><subject>Anti-Inflammatory Agents - therapeutic use</subject><subject>Antibodies, Monoclonal - therapeutic use</subject><subject>Biological products</subject><subject>Clinical trials</subject><subject>Comorbidity</subject><subject>Dermatologic Agents - therapeutic use</subject><subject>Dermatology</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Older people</subject><subject>Psoriasis</subject><subject>Psoriasis - therapy</subject><subject>Science & Technology</subject><subject>Systematic review</subject><subject>Tumor Necrosis Factor-alpha - antagonists & inhibitors</subject><issn>1203-4754</issn><issn>1615-7109</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><recordid>eNqNkc1LHTEUxYO0qLXuuyqBbgplau4kmSTu7MN-ISitxeWQydyxkZmJTTKV9983j2ctCEJXCTm_c7g5l5BXwN4DKHUENeNCSQFGGyWV3iH70ICsFDDzrNyLXG30PfIipRvGGIAUu2SPg5FMS75Pvn7wYQzX3tHLiDZPOGfqZ3o69hjHNb2w2ZenRK98_kkvUojeJp-O6Qn9vk4Zp6I7-g1_e7x7SZ4Pdkx4eH8ekB8fTy9Xn6uz809fVidnleONzJXgwIQeeAfKDlrWpra9dIbbHrpucJ3QohGdQ9M77QZkg256bDqlEIwBbfkBebvNvY3h14Ipt5NPDsfRzhiW1NZcQFPXmsuCvnmE3oQlzmW6Qula1pJzXSi2pVwMKUUc2tvoJxvXLbB203P7uOdieX0fvHQT9g-Gv8UWQG-BO-zCkFxp0eEDVjYhWYkRkm2WsvK59BjmVVjmXKzv_t9a6GpLJ3uN_7735OR_AKOppIE</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Sandhu, Vijay Kumari</creator><creator>Ighani, Arvin</creator><creator>Fleming, Patrick</creator><creator>Lynde, Charles W.</creator><general>SAGE Publications</general><general>Sage</general><general>SAGE PUBLICATIONS, INC</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5695-6798</orcidid><orcidid>https://orcid.org/0000-0003-2238-7106</orcidid><orcidid>https://orcid.org/0000-0001-9163-5463</orcidid></search><sort><creationdate>202003</creationdate><title>Biologic Treatment in Elderly Patients With Psoriasis: A Systematic Review</title><author>Sandhu, Vijay Kumari ; 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However, psoriasis treatment in older adults can be challenging, given an increased number of comorbid conditions and immunosenescence. Biologic agents present a solution to this treatment dilemma because of their high efficacy and favorable tolerability. The objective of this systematic review was to summarize the findings of clinical trial and real-world studies exploring the safety and efficacy of biologic agents in elderly patients with moderate-to-severe psoriasis. We searched MEDLINE, Embase, the Cochrane Library, and clinical trial databases. Studies analyzing biologics for psoriasis were included if elderly patients were the main population of interest or were a separate subgroup in their analysis. Eighteen articles met inclusion criteria after screening. Across all biologic classes, efficacy for biologics between nonelderly adult patient and elderly patients was similar. Adverse events (AEs) and infections occured at a similar frequency between both groups. However, serious AEs were more common in the elderly. The available literature on the safety and efficacy of biologic agents in elderly patients supports the use of these agents in this population. However, serious AEs and discontinuation due to AEs were more common in older patients. As elderly patients have a higher burden of comorbid conditions and an increased baseline vulnerability for AE, physicians should continue to be prudent in screening before initiating biologics and monitor patients more closely as AEs tend to be more severe.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>31950853</pmid><doi>10.1177/1203475419897578</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-5695-6798</orcidid><orcidid>https://orcid.org/0000-0003-2238-7106</orcidid><orcidid>https://orcid.org/0000-0001-9163-5463</orcidid></addata></record> |
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subjects | Anti-Inflammatory Agents - therapeutic use Antibodies, Monoclonal - therapeutic use Biological products Clinical trials Comorbidity Dermatologic Agents - therapeutic use Dermatology Humans Life Sciences & Biomedicine Older people Psoriasis Psoriasis - therapy Science & Technology Systematic review Tumor Necrosis Factor-alpha - antagonists & inhibitors |
title | Biologic Treatment in Elderly Patients With Psoriasis: A Systematic Review |
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