BACKGROUND: Scarce data related to the drug survival of biologic agents in psoriasis patients aged ≥65 years is available. OBJECTIVES: To evaluate the drug survival of interleukin (IL)-23 or the IL-17 inhibitors approved for the treatment of moderate-to-severe psoriasis in elderly patients (aged ≥65 years), compared with younger adult patients (aged <65 years), and to identify clinical predictors that can influence the drug survival. METHODS: This retrospective multicentric cohort study included adult patients with moderate-to-severe psoriasis, dissecting two-patient subcohorts based on age: elderly versus younger adults. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. RESULTS: We included 4178 patients and 4866 treatment courses; 934 were elderly (1072 treatment courses), and 3244 were younger patients (3794 treatment courses). Drug survival, considering all causes of interruption, was higher in patients aged <65 years than in elderly patients overall (log-rank p < 0.006). This difference was significant for treatment courses involving IL-23 inhibitors (p < 0.001) but not for those with IL-17 inhibitors (p = 0.2). According to both uni- and multi-variable models, elder age was associated with an increased risk of treatment discontinuation (univariable analysis: HR: 1.229, 95% CI 1.062-1.422; p < 0.006; multivariable analysis: HR: 1.199, 95% CI 1.010-1.422; p = 0.0377). Anti-IL-23 agents were associated with a reduced likelihood of treatment discontinuation after adjusting for other variables (HR: 0.520, 95% CI 0.368-0.735; p < 0.001). Being previously treated with IL-17 inhibitors increased the probability of discontinuation. CONCLUSIONS: Elderly patients with psoriasis have an increased risk of biologic treatment discontinuation compared with younger adult patients, particularly, if being treated with IL-23 inhibitors. However, in stratified analyses conducted in elderly patients, IL-23 inhibitors showed higher drug survival rates than IL-17 inhibitors.

2nd Department of Dermatology Venereology Aristotle University School of Medicine Thessaloniki Greece

Center for Health Technology and Services Research Porto Portugal

Clínica Médica Belém Lisbon Portugal

Department of Dermatology CAC ICBAS CHP Centro Académico Clínico ICBAS CHP Porto Portugal

Department of Dermatology Germans Trias i Pujol University Hospital Badalona Spain

Department of Dermatology Hospital de la Santa Creu i Sant Pau Barcelona Spain

Department of Dermatology Lausanne University Hospital CHUV and University of Lausanne Lausanne Switzerland

Department of Dermatology University of Pisa Pisa Italy

Department of Dermatovenereology 3rd Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Czech Republic

Department of Medicine The Lynde Institute for Dermatology University of Toronto Toronto Ontario Canada

Department of Reconstructive and Aesthetic Plastic Surgery University of Milan Milan Italy

Dermatologia Dipartimento di Scienze Mediche e Chirurgiche Fondazione Policlinico Universitario A Gemelli IRCCS Rome Italy

Dermatologia Dipartimento Universitario di Medicina e Chirurgia Traslazionale Università Cattolica Del Sacro Cuore Rome Italy

Dermatology Center Hospital CUF Descobertas Lisbon Portugal

Dermatology Department Hospital Universitario de la Princesa Instituto de Investigación Sanitaria La Princesa Madrid Spain

Dermatology Unit Department of Medicine University of Padua Padua Italy

Division of Dermatology Department of Medicine Probity Medical Research University of Toronto Waterloo Ontario Canada

ITR Laboratory for Integrative and Translational Research in Population Health Porto Portugal

McMaster University Hamilton Ontario Canada

Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy

Section of Dermatology Department of Dermatological Science University of Florence Florence Italy

UMIB Unit for Multidisciplinary Research in Biomedicine Instituto de Ciências Biomédicas Abel Salazar University of Porto Porto Portugal

Unit of Dermatology University of Campania Luigi Vanvitelli Naples Italy

University Hospital of Venereal and Skin Diseases A Sygros Athens Greece

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