Department of Dermatology, Radboud University Medical Centre, Post Office Box 9101, NL-6500 HB Nijmegen, The Netherlands.
Department for Health Evidence, Radboud university medical centre, Nijmegen, the Netherlands.
Acta Derm Venereol. 2022 Oct 31;102:adv00805. doi: 10.2340/actadv.v102.2412.
Optimal selection of systemic therapy in older adults with psoriasis can be challenging, due to sparse evidence-based guidance. This multicentre retrospective study investigated the safety of systemic therapy with causality assessment in a real-world cohort of older adults (≥ 65 years) with psoriasis. Data from 6 hospitals on (serious) adverse events were collected, causality assessment performed and incidence rate ratios calculated. Potential predictors for adverse events-occurrence were studied using multivariable logistic regression analysis. In total, 117 patients with 176 treatment episodes and 390 patient-years were included, comprising 115 (65.3%) and 61 (34.7%) treatment episodes with conventional systemic therapy and biologics/apremilast, respectively. After causality assessment, 232 of 319 (72.7%) adverse events remained and were analysed further, including 12 serious adverse events. No significant differences in incidence rate ratios were found between the systemic treatment types. In regression analysis, increasing age was associated with causality assessed adverse events-occurrence (odds ratio 1.195; p=0.022). Comorbidity, polypharmacy, and treatment type were not associated with causality assessed adverse events-occurrence. In conclusion, increasing age was associated with a higher causality assessed adverse events-occurrence. Causality assessed serious adverse events were rare, reversible and/or manageable in clinical practice. In conclusion, the safety profile of systemic antipsoriatic therapy within this population is reassuring.
在老年银屑病患者中选择全身性治疗可能具有挑战性，因为缺乏基于证据的指导。这项多中心回顾性研究在真实世界的老年（≥65 岁）银屑病患者队列中调查了全身性治疗的安全性，并进行了因果关系评估。从 6 家医院收集了关于（严重）不良事件的数据，进行了因果关系评估，并计算了发病率比值。使用多变量逻辑回归分析研究了不良事件发生的潜在预测因素。共纳入 117 例患者的 176 个治疗期和 390 个患者年，包括 115（65.3%）和 61（34.7%）例分别接受常规全身性治疗和生物制剂/阿普米司特治疗的治疗期。在因果关系评估后，319 例（72.7%）不良事件中的 232 例仍然存在，并进一步进行了分析，包括 12 例严重不良事件。两种全身性治疗类型之间的发病率比值无显著差异。在回归分析中，年龄增加与因果关系评估的不良事件发生相关（比值比 1.195；p=0.022）。合并症、多药治疗和治疗类型与因果关系评估的不良事件发生无关。总之，年龄增加与因果关系评估的不良事件发生相关。在临床实践中，因果关系评估的严重不良事件罕见、可逆转和/或可管理。总之，该人群中全身性抗银屑病治疗的安全性令人放心。
