Efficacy & safety of IL-17 & IL-23 inhibitors in elderly psoriasis patients

[Fred]

In this retrospective study, 121 patients with moderate-to-severe plaque psoriasis treated with Cosentyx (secukinumab), Taltz (ixekizumab), Tremfya (guselkumab), or Skyrizi (risankizumab) were analysed.

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Biologic therapies targeting interleukin (IL)-17 and IL-23 have transformed psoriasis treatment, yet real-world evidence on the impact of age on treatment responses and drug survival is limited.

This study aims to compare early (12/16 weeks), mid term (24 weeks) and long term (52 weeks) Psoriasis Area and Severity Index (PASI) responses and drug survival in psoriasis patients aged < 65 versus ≥ 65 years receiving IL-17 or IL-23 inhibitors. In this retrospective study, 121 patients with moderate-to-severe plaque psoriasis treated with secukinumab, ixekizumab, guselkumab, or risankizumab were analyzed.

Patients were stratified into two age groups (< 65, n = 78; ≥ 65, n = 43). PASI75, PASI90, and PASI < 2 outcomes were assessed at 12/16, 24, and 52 weeks. Drug survival was evaluated via Kaplan–Meier analysis (censoring at 24 months) and Cox regression was used to identify predictors of discontinuation. At 12/16 weeks, the < 65 group achieved significantly higher PASI75 (90.5% vs. 65.1%, p = 0.010), PASI90 (75.7% vs. 32.6%, p = 0.030) and PASI < 2 (55.8% vs. 79.7%, p = 0.006) responses than the ≥ 65 group. At 52 weeks, PASI75, PASI90, and PASI < 2 rates were similar between groups (86.3% vs. 97.5%, p = 0.055; 78% vs. 90%, p = 0.112; 85.1% vs. 92.5%, p = 0.253).

There were no significant differences between IL-17 and IL-23 inhibitors within any age group. Overall drug survival at 24 months was high (79.6% for < 65 and 90.3% for ≥ 65, log-rank p = 0.407), with no difference between biologic classes (mean survival: 21.8 vs. 22.4 months, p = 0.520). In Cox regression, female sex (HR 0.23, p = 0.005) and higher baseline PASI (HR 1.093 per point, p = 0.013) predicted discontinuation, whereas age, biologic class, BMI, and prior biologic use were not significant.

Despite a delayed initial response, older patients achieve long-term PASI outcomes comparable to younger patients when treated with IL-17 and IL-23 inhibitors. Drug survival is similarly excellent across age groups and biologic classes.

These findings support the successful use of modern biologics in elderly psoriasis patients.

Source: onlinelibrary.wiley.com

*Funding: The authors received no specific funding for this work.

Cosentyx (secukinumab)
Taltz (ixekizumab)
Tremfya (guselkumab)
Skyrizi (risankizumab)

[Forest Walker]

That's good news!

[D Foster]

I have been on Stelara now for 11 years which is both a IL17 and 23 inhibitor and it still works well for me so it good to see that the use of biologics are proving effective in older patients.

[Fred]

I have been on Stelara now for 11 years which is both a IL17 and 23 inhibitor and it still works well for me so it good to see that the use of biologics are proving effective in older patients.

Stelara is IL 12 & 23 Dave

Biological Treatments For Psoriasis

[D Foster]

Sorry Fred ,yes it's IL12 but what I should have said is Stelara does not directly target IL-17, but it does affect the IL-17 pathway. Stelara is a human monoclonal antibody that binds to the shared p40 subunit of IL-12 and IL-23. By blocking these cytokines, it indirectly influences the IL-17 pathway.

[Fred]

Yes IL 17 does seem to be the top one to go for these days my Bimzelx goes after 17F & 17A.

We can but hope one day they will find the true culprit.

[Caroline]

Great results for the elderly

What I see is the following.
At 12/16 weeks, the < 65 group achieved significantly higher
PASI75 (90.5% vs. 65.1%, p = 0.010),
PASI90 (75.7% vs. 32.6%, p = 0.030) and
PASI < 2 (55.8% vs. 79.7%, p = 0.006)

At PASi75 the younger are doing significantly better than the elderly.
Identical for PASI90
But… for PASI < 2, which means almost complete or complete remission, the elderly suddenly do better.



That is quite not logical..

[Fred]

Great results for the elderly   

What I see is the following.
At 12/16 weeks, the < 65 group achieved significantly higher
PASI75 (90.5% vs. 65.1%, p = 0.010),
PASI90 (75.7% vs. 32.6%, p = 0.030) and
PASI < 2 (55.8% vs. 79.7%, p = 0.006)

At PASi75 the younger are doing significantly better than the elderly.
Identical for PASI90
But… for PASI < 2, which means almost complete or complete remission, the elderly suddenly do better.



That is quite not logical..

Maybe as we get older it helps, mine has got better the older I get but that could be down to Bimzelx.

[D Foster]

Great results for the elderly   

What I see is the following.
At 12/16 weeks, the < 65 group achieved significantly higher
PASI75 (90.5% vs. 65.1%, p = 0.010),
PASI90 (75.7% vs. 32.6%, p = 0.030) and
PASI < 2 (55.8% vs. 79.7%, p = 0.006)

At PASi75 the younger are doing significantly better than the elderly.
Identical for PASI90
But… for PASI < 2, which means almost complete or complete remission, the elderly suddenly do better.



That is quite not logical..

Maybe as we get older it helps, mine has got better the older I get but that could be down to Bimzelx. 

I would suspect that with age the body changes , hormone levels and things like that and the way the older person's body tolerance will make the difference but the younger body , taking in to consideration hormones etc , may not be as stable and takes time to adjust.

[Caroline]

Great results for the elderly   

What I see is the following.
At 12/16 weeks, the < 65 group achieved significantly higher
PASI75 (90.5% vs. 65.1%, p = 0.010),
PASI90 (75.7% vs. 32.6%, p = 0.030) and
PASI < 2 (55.8% vs. 79.7%, p = 0.006)

At PASi75 the younger are doing significantly better than the elderly.
Identical for PASI90
But… for PASI < 2, which means almost complete or complete remission, the elderly suddenly do better.



That is quite not logical..

Maybe as we get older it helps, mine has got better the older I get but that could be down to Bimzelx. 

I would suspect that with age the body changes , hormone levels and things like that and the way the older person's body tolerance will make the difference but the younger body , taking in to consideration hormones etc , may not be as stable and takes time to adjust.

I think it is just a mistake, as it is totally not logical, and it should be the other way around.

I also think the younger body is way more flexible as the older body. I admit that there may be a stable period, but on the whole the older body gets worn out and inherently less stable.