Safety concerns with current treatments for psoriasis in the elderly

ABSTRACT

Introduction: The approach to manage psoriasis in the elderly (ages ≥65 years) patients can be challenging. They often suffer from multiple comorbidities and polypharmacy with possible adverse effects and undergo a progressive functional impairment of the immune system that increases susceptibility to infections as well as to auto-reactivity. Despite the increasing aging of the general population and although several therapies are currently available for psoriasis treatment, data regarding their use and tolerability in the elderly are quite limited.

Areas covered: This review focuses on topical and systemic therapies that have been investigated in elderly patients in order to provide their safety profile in this population.

Expert opinion: Conventional systemic therapies in elderly patients should be carefully dispensed and the correct dosage individually determined, taking into account the metabolism changes, organ impairment, comorbidities, concomitant medications, and contraindications. Apremilast, due to its satisfactory safety profile and low risk of drug interactions, results as an appropriate treatment option for elderly patients. Biologics (TNF-α, IL-12/23, IL-17, and IL-23 inhibitors) come out as safe and long-term options for the management of these patients resulting not associated with a higher risk of adverse events.

KEYWORDS:

• Biologics
• elderly
• non-biological systemic therapies
• psoriasis
• safety profile

Article highlights

• Data on the use and tolerability of the current therapies available for psoriasis treatment in the elderly are quite limited.

• Patients over 65 years were often not included or underrepresented in randomized clinical trials.

• Topical agents are often prescribed as first-line therapy in elderly patients resulting as insufficient in some cases.

• Phototherapy may be a safe therapeutic approach in patients who cannot achieve improvement with topical agents.

• Conventional systemic therapies in elderly patients should be carefully dispensed and the correct dosage individually determined.

• Apremilast and biologics come out as safe and long-term options for elderly patients resulting not associated with a higher risk of AEs.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.