Age-based treatment differences in and reluctance to treating older adults with systemic antipsoriatic therapy – a mixed-method pilot study

Abstract

Background

Evidence-based guidance in older adults (≥65 years) with psoriasis is sparse and undertreatment might be present.

Objectives

To assess prescribing patterns, comfort levels, barriers and needs of dermatologists when treating older adults with systemic antipsoriatic therapy.

Methods

A mixed-methods design was used including a survey among all Dutch dermatologists and residents, followed by semi-structured interviews.

Results

Most of the survey respondents applied systemic treatment to the same extent in older versus younger patients (n = 49; 67.1%) and weren’t reluctant prescribing systemic therapy (n = 50; 68.5%) in older adults. However, 26% (n = 19) of the respondents treated older adults less often with systemic therapy compared to younger patients and 68.1% (n = 49) performed additional actions in older adults, e.g. intensified monitoring or dose reduction. Based on the survey and interviews (n = 10), the main reasons for these age-based treatment differences were comorbidity, comedication, and fear of adverse events. More evidence-based guidance, education, and time to assess older adults were identified as most important needs, especially regarding frailty screening.

Conclusions

Age-based treatment differences in and reluctance to treating older adults with systemic antipsoriatic therapy were common. There is a need for more evidence-based guidance, education, and consultation time, to improve treatment in this growing population.

Keywords:

• Psoriasis
• older adults
• geriatric psoriasis
• treatment patterns
• treatment-reluctance

Acknowledgements

The authors are grateful to all respondents and interview participants who participated in this study.

Disclosure statement

E.L.M. ter Haar has carried out investigator-initiated research with financial support from Almirall and has carried out clinical trials for Novartis. P.C.M. van de Kerkhof serves as the chief medical officer of the International Psoriasis Council, editor of the Journal of dermatological treatment and received fees for lectures and consultancies from Bristol Mayer Squib, UCB, Leo Pharma, Eli Lilly and Company, Dermavant, Almirall, Celgene Novartis, Janssen, and AbbVie. E.M.G.J. de Jong has received research grants for the independent research fund of the department of dermatology of the Radboud university medical center Nijmegen, the Netherlands from AbbVie, BMS, Janssen Pharmaceutica, Leo Pharma, Novartis, and UCB for research on psoriasis, has acted as consultant and/or paid speaker for and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis or eczema including AbbVie, Amgen, Almirall, Celgene, Galapagos, Janssen Pharmaceutica, Lilly, Novartis, Leo Pharma, Sanofi and UCB. All funding is not personal but goes to the independent research fund of the department of dermatology of Radboud University medical center Nijmegen, the Netherlands.S.F.K. Lubeek has received research grants for investigator-initiated research by Almirall, and has acted as consultant and/or paid speaker for Janssen, LEO Pharma, Almirall, Sanofi Genzyme and Sunpharma. All funding is not personal but goes to the independent research fund of the department of dermatology of Radboud university medical center Nijmegen, the Netherlands. No other potential conflicts of interest were reported.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This investigator-initiated study was conducted with financial support from Almirall. The funding source had no influence on study design, data collection and analysis, nor the content of the manuscript.