Age and biologic survival in patients with moderate-to-severe psoriasis: A cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR)

The current management of psoriasis does not differentiate between young and old patients in selecting the safest and/or most effective biologic. To explore the effect of age at treatment initiation in response to biologics in patients with moderate-to-severe psoriasis in the UK and Eire. Data from patients registering to the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) from 2007-2024 on first course of Tumour Necrosis Factor (TNF), interleukin (IL) 12/13, IL-17 and IL-23 inhibitors (i) with at least 6 months' follow-up were included. Patients aged ≥16 years at registration were grouped into 16-24, 25-34, 35-44, 45-54, 55-64, 65-74, and ≥75 year cohorts with 45-54 years as the Reference Cohort. Biologic survival was defined as the time between treatment initiation to its discontinuation associated with ineffectiveness or occurrence of adverse events (AEs). Adjusted hazard ratio (aHR) with 95% confidence interval (CI) was estimated using a flexible parametric model to compare discontinuing therapy between age groups. Each model included exposure (biologic class), effect modifier (age groups), interaction terms, baseline demographic, clinical, and disease severity covariates. There were 14,294 patients included; 847 (6%) 16-24; 2,502 (18%) 25-34; 3,575 (25%) 35-44; 3,863 (27%) 45-54; 2,338 (16%) 55-64; 954 (7%) 65-74; and 215 (2%) ≥75 years. The interaction effects model showed individuals aged 16-24 years were more likely to discontinue TNFi due to ineffectiveness compared with the Reference Cohort (45-54 years) [aHR (95% CI) 1.30 (1.10, 1.55)]. For survival associated with AEs, individuals aged 55-64 years were at higher risk of discontinuing TNFi and IL12/23i [1.33 (1.13, 1.56) and 1.34 (1.03, 1.75), respectively], those aged 65-74 years were more likely to discontinue TNFi, IL-12/23i and IL-17i [1.89 (1.54, 2.31), 2.00 (1.47, 2.73) and 1.69 (1.08, 2.64), respectively] whereas individuals aged ≥75 years were at higher risk of discontinuing the four biologic classes. Psoriasis patients aged 16-24 years are more likely to stop TNFi due to ineffectiveness whereas those aged ≥55 years are more likely to stop biologics due to AEs. These large real-world findings provide important information for clinicians treating people with moderate-to-severe psoriasis across all age groups.