Younger Psoriasis Patients More Likely to Stop TNFi, Older Patients Face Adverse Events: Study From BADBIR

The study revealed that younger patients (16-24 years) with moderate-to-severe psoriasis were more likely to discontinue TNF inhibitors due to lack of effectiveness. In comparison, older patients (55 years and above) faced a higher risk of stopping treatment due to adverse events. Notably, patients aged 65-74 exhibited high discontinuation rates across multiple biologic classes.

The researchers note that currently, psoriasis management does not tailor biologic selection based on patient age to ensure the safest and most effective treatment. To address this gap, Oras A Alabas, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester, Manchester, UK, and colleagues aimed to investigate the impact of age at treatment initiation on the response to biologics in patients with moderate-to-severe psoriasis in the UK and Eire.

For this purpose, the researchers included data from patients registered in the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) between 2007 and 2024, focusing on their first course of Tumour Necrosis Factor (TNF) inhibitors, interleukin (IL) 12/13 inhibitors, IL-17, and IL-23 inhibitors, with at least 6 months of follow-up. Patients aged ≥16 years were grouped into the following age cohorts: 16-24, 25-34, 35-44, 45-54, 55-64, 65-74, and ≥75 years, with the 45-54 age group serving as the reference cohort. Biologic survival was defined as the period from treatment initiation to its discontinuation due to ineffectiveness or adverse events (AEs).

The adjusted hazard ratio (aHR) with a 95% confidence interval (CI) was estimated using a flexible parametric model to compare therapy discontinuation rates across age groups. Each model accounted for biologic class, age group, interaction terms, and various baseline demographic, clinical, and disease severity covariates.

Key Findings:

• The study included 14,294 patients: 847 (6%) aged 16-24, 2,502 (18%) aged 25-34, 3,575 (25%) aged 35-44, 3,863 (27%) aged 45-54, 2,338 (16%) aged 55-64, 954 (7%) aged 65-74, and 215 (2%) aged ≥75 years.
• Patients aged 16-24 were more likely to discontinue TNF inhibitors (TNFi) due to ineffectiveness compared to the reference cohort (45-54 years), with an adjusted hazard ratio (aHR) of 1.30.
• Individuals aged 55-64 had a higher risk of discontinuing TNFi and IL-12/23 inhibitors due to adverse events (AEs), with aHRs of 1.33 and 1.34, respectively.
• Those aged 65-74 were more likely to discontinue TNFi, IL-12/23i, and IL-17i due to AEs, with aHRs of 1.89, 2.00, and 1.69, respectively.
• Individuals aged ≥75 years had a higher risk of discontinuing all four biologic classes (TNFi, IL-12/23i, IL-17i, and IL-23i) due to AEs.

The findings suggest that patients with psoriasis aged 16-24 years are more likely to discontinue TNFi due to ineffectiveness, while those aged ≥55 years are more prone to stopping biologics due to adverse events (AEs).

"These large, real-world findings offer valuable insights for clinicians managing moderate-to-severe psoriasis across different age groups, helping to tailor treatment strategies effectively," the researchers concluded.

Reference:

Alabas, O. A., Mason, K. J., Yiu, Z. Z., Smith, C. H., Warren, R. B., Griffiths, C. E., Barker, J., Morrison, S., Bewley, A., Evans, I., Griffiths, C., Ahmed, S., Kirby, B., Kleyn, E., Laws, P., Hampton, P., Alabas, O., McElhone, K., Yiu, Z., . . . Zietemann, V. Age and biologic survival in patients with moderate-to-severe psoriasis: A cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). British Journal of Dermatology. https://doi.org/10.1093/bjd/ljaf017