Efficacy and safety of ustekinumab treatment in elderly patients with psoriasis

The ratio of the elderly among psoriasis patients has been increasing. However, satisfactory long‐term management of psoriasis for the elderly is challenging because of the more frequent presence of comorbidities, and the higher risk of adverse events from systemic therapeutic agents than younger patients. The use of ustekinumab (UST) appears to be an appropriate systemic treatment because it is considered less likely to cause adverse events than other systemic treatments, as well as necessitating fewer hospital visits. Our retrospective study aimed to evaluate the efficacy and safety profile of UST in elderly patients with psoriasis. The study included 24 patients aged over 65 years (range, 65–88 years; mean, 73.1 years) with moderate to severe plaque psoriasis with impaired quality of life. Efficacy and safety were assessed over a 1‐year period using the Psoriasis Area and Severity Index (PASI) and the Dermatology Live Quality Index (DLQI). The efficacy was evaluated by the proportion of subjects who achieved ≥75% reduction in PASI score (PASI 75). PASI 75 responses were 56.5% at week 16, 59.1% at week 28, and 60.0% at week 52. None of the patients developed any serious infection during the 1‐year treatment. The mean DLQI score at weeks 0, 16, 28, and 52 was 7.8 ± 6.0, 2.5 ± 3.4, 1.4 ± 1.7, and 1.2 ± 1.7, respectively. UST showed sufficient efficacy for elderly patients with psoriasis without any serious infection over the 1‐year treatment. Our results suggest that UST is the preferable agent for the treatment of elderly patients with psoriasis.

[1]  Andrea De Maria,et al.  Immunology of Tuberculosis , 2014, Mediterranean journal of hematology and infectious diseases.

[2]  T. Tsai Hepatitis B virus reactivation after ustekinumab treatment: reply from authors , 2014, The British journal of dermatology.

[3]  T. Purnak,et al.  Hepatitis B virus reactivation after ustekinumab treatment , 2014, The British journal of dermatology.

[4]  Steven R. Cohen,et al.  Ustekinumab associated with flares of psoriatic arthritis. , 2013, JAMA dermatology.

[5]  S. Chimenti,et al.  Efficacy and Safety of Subcutaneous Anti-Tumor Necrosis Factor-Alpha Agents, Etanercept and Adalimumab, in Elderly Patients Affected by Psoriasis and Psoriatic Arthritis: An Observational Long-Term Study , 2012, Dermatology.

[6]  M. Song,et al.  The safety of ustekinumab treatment in patients with moderate‐to‐severe psoriasis and latent tuberculosis infection , 2012, The British journal of dermatology.

[7]  L. Puig,et al.  Ustekinumab in clinical practice: response depends on dose and previous treatment , 2012, Journal of the European Academy of Dermatology and Venereology : JEADV.

[8]  H. Nakagawa,et al.  Efficacy and safety of ustekinumab in Japanese patients with moderate‐to‐severe plaque‐type psoriasis: Long‐term results from a phase 2/3 clinical trial , 2012, The Journal of dermatology.

[9]  K. Reich,et al.  Efficacy of biologics in the treatment of moderate to severe psoriasis: a network meta‐analysis of randomized controlled trials , 2012, The British journal of dermatology.

[10]  P. Leonard,et al.  Interleukin-12 , 2012, BioDrugs.

[11]  L. Skov,et al.  Responses to ustekinumab in the anti‐TNF agent‐naïve vs. anti‐TNF agent‐exposed patients with psoriasis vulgaris , 2011, Journal of the European Academy of Dermatology and Venereology : JEADV.

[12]  A. Gottlieb,et al.  Psoriasis in the elderly: from the Medical Board of the National Psoriasis Foundation. , 2011, Journal of the American Academy of Dermatology.

[13]  E. Dauden,et al.  Incidence of tuberculosis infection in psoriatic patients on anti‐TNF therapy: report of a case series with 144 patients , 2011, Journal of the European Academy of Dermatology and Venereology : JEADV.

[14]  H. Nakagawa,et al.  Infliximab monotherapy in Japanese patients with moderate-to-severe plaque psoriasis and psoriatic arthritis. A randomized, double-blind, placebo-controlled multicenter trial. , 2010, Journal of dermatological science.

[15]  J. Keane,et al.  How tumour necrosis factor blockers interfere with tuberculosis immunity , 2010, Clinical and experimental immunology.

[16]  H. Nakagawa,et al.  Adalimumab in Japanese patients with moderate to severe chronic plaque psoriasis: Efficacy and safety results from a Phase II/III randomized controlled study , 2010, The Journal of dermatology.

[17]  R. Bissonnette,et al.  Safety of Conventional Systemic Agents and Biologic Agents in the Treatment of Psoriasis , 2009, Journal of cutaneous medicine and surgery.

[18]  A. Menter,et al.  Tuberculosis and tumour necrosis factor‐α inhibitor therapy: a report of three cases in patients with psoriasis. Comprehensive screening and therapeutic guidelines for clinicians , 2009, The British journal of dermatology.

[19]  A. Åsberg,et al.  Reduced Elimination of Cyclosporine A in Elderly (>65 Years) Kidney Transplant Recipients , 2008, Transplantation.

[20]  M. Lebwohl,et al.  National Psoriasis Foundation consensus statement on screening for latent tuberculosis infection in patients with psoriasis treated with systemic and biologic agents. , 2008, Journal of the American Academy of Dermatology.

[21]  Darrell B. O'Quinn,et al.  Emergence of the Th17 pathway and its role in host defense. , 2008, Advances in immunology.

[22]  J. Gómez-Reino,et al.  Risk of tuberculosis in patients treated with tumor necrosis factor antagonists due to incomplete prevention of reactivation of latent infection. , 2007, Arthritis and rheumatism.

[23]  D. Furst,et al.  Disease-modifying antirheumatic drug use in the elderly rheumatoid arthritis patient. , 2005, Clinics in geriatric medicine.

[24]  J. Gómez-Reino,et al.  Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. , 2005, Arthritis and rheumatism.

[25]  H. Nakagawa,et al.  Long‐Term Continuous versus Intermittent Cyclosporin: Therapy for Psoriasis , 2003, The Journal of dermatology.

[26]  A. Giannetti,et al.  Clinical trial of the efficacy and safety of oral etretinate with calcipotriol cream compared with etretinate alone in moderate-severe psoriasis. , 1999, Journal of the European Academy of Dermatology and Venereology : JEADV.

[27]  A. Gottlieb,et al.  Cyclosporine consensus conference: with emphasis on the treatment of psoriasis. , 1998, Journal of the American Academy of Dermatology.

[28]  M C Bialas,et al.  Adverse effects of corticosteroids. , 1998, Adverse drug reactions and toxicological reviews.

[29]  L. Kurland,et al.  Incidence of psoriasis in Rochester, Minn, 1980-1983. , 1991, Archives of dermatology.

[30]  R. Coskey Adverse effects of corticosteroids: I. Topical and intralesional. , 1986, Clinics in dermatology.