793812366 Faculty of Medicine, University of Toronto, Canada.
Department of Family and Community Medicine, University of Toronto, Canada.
J Cutan Med Surg. 2021 Jul-Aug;25(4):397-408. doi: 10.1177/1203475421993770. Epub 2021 Feb 10.
Psoriasis and atopic dermatitis are common among older adults (≥65 years old), but clinical trials often exclude that population.
To synthesize evidence from observational studies on the safety of systemic therapies (conventional or biologic) for psoriasis and atopic dermatitis among older adults in a systematic review.
We searched MEDLINE and EMBASE (inception to October 31, 2019) and included observational studies reporting adverse events among older people treated with systemic therapy for psoriasis or atopic dermatitis. Outcomes were death, hospitalization, emergency department visits, infections, major cardiovascular events, renal toxicity, hepatotoxicity, and cytopenias. We assessed study quality using the Newcastle-Ottawa Scale.
We included 22 studies on treatment for psoriasis and 2 for atopic dermatitis. Most studies were small and non-comparative and 20 of 24 were low quality. Studies comparing safety between medications or medication classes or between older and younger adults did not show apparent differences but had wide confidence intervals around relative effect estimates. Heterogeneity of study design and reporting precluded quantitative synthesis.
There is scant evidence on the safety of conventional systemic and biologic medications for older adults with psoriasis or atopic dermatitis; older adults and their clinicians should be aware of this evidence gap.
银屑病和特应性皮炎在老年人（≥65 岁）中较为常见，但临床试验通常将该人群排除在外。
通过系统评价，综合观察性研究中关于老年人使用全身性治疗（常规或生物制剂）治疗银屑病和特应性皮炎的安全性证据。
我们检索了 MEDLINE 和 EMBASE（从建库至 2019 年 10 月 31 日），并纳入了报告老年人接受全身性治疗银屑病或特应性皮炎后不良事件的观察性研究。结局指标为死亡、住院、急诊就诊、感染、主要心血管事件、肾毒性、肝毒性和细胞减少症。我们使用纽卡斯尔-渥太华量表评估研究质量。
我们纳入了 22 项关于银屑病治疗的研究和 2 项关于特应性皮炎治疗的研究。大多数研究规模较小且为非对照研究，24 项研究中有 20 项质量较低。比较药物或药物类别之间以及老年人和年轻人之间安全性的研究并未显示出明显差异，但相对效应估计值的置信区间较宽。研究设计和报告的异质性使得无法进行定量综合。
关于常规全身性药物和生物制剂治疗老年人银屑病或特应性皮炎的安全性证据较少；老年人及其临床医生应意识到这一证据空白。
