Treating psoriasis in the elderly: biologics and small molecules

ABSTRACT

Introduction

Psoriasis prevalence in the elderly is growing. It is estimated that 15% of elderly psoriasis patients suffer from moderate-to-severe disease, thus requiring systemic treatments. However, conventional systemic agents’ use is limited due to contraindications and drug-interactions. Conversely, biologics and small molecules seem to be a valuable option, although the geriatric psoriasis population is frequently excluded from trials and shared guidelines are lacking.

Areas covered

Relevant English literature (trials, real-life studies, case series, and reviews) regarding biologics and/or small molecules in the elderly were searched for up to January 17, 2022.

Expert opinion

Treatment of moderate-to-severe psoriasis in the elderly may be challenging due to multiple comorbidities, polypharmacy, and increased risk of infections and cancers. However, new targeted therapies offer the possibility to perform a tailored-tail management, considering comorbidities, drug-interactions, and frailties which characterize this class of patients. Several real-world data support biologics and small molecules’ efficacy and safety in the elderly with mainly no significant difference as compared to young adults. Elderly psoriasis patients’ expectations are as high as those of their younger counterparts. Hence, they deserve the best therapeutic options according to their peculiarities for a long-term psoriasis remission and an improved quality of life.

KEYWORDS:

• Elderly
• psoriasis
• geriatric
• treatment
• biologics
• small molecules

Article highlights

• Psoriasis can affect people of any age and 3–13% of cases may directly develop during old age

• With an ageing population, this prevalence is expected to increase exponentially

• Fifteen percent elderly psoriasis patients suffer from moderate-to-severe disease, thus requiring systemic treatments

• Treatment management is challenging, and guidelines are lacking due to the scarce representation of the geriatric population in clinical trials

• Multiple comorbidities, polypharmacy, immunosenescence, and logistic issues may influence the therapeutic choice

• Therapeutic expectations of the elderly are the same of younger patients

• Conventional systemic treatments (methotrexate, acitretin, cyclosporine) may be frequently contraindicated in the elderly for their well-known side effects and drug interactions

• Phototherapy may be inconvenient for procedural reasons

• Biologicals and small molecules may represent an invaluable opportunity for their efficacy and safety profile

• Much evidence supports the use of biologicals and small molecules in elderly psoriasis patients

Declaration of interest

M Megna has acted as consultant or speaker for Abbvie, Eli Lilly, UCB, Novartis, Janssen, Amgen and Leo Pharma. G Fabbrocini has acted as consultant or speaker for Abbvie, Eli Lilly, UCB, Novartis, Janssen, Amgen, Almirall and Leo Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.