TOPLINE:

In a population-based cohort study of older adults with psoriasis or psoriatic arthritis (PsA), the use of anti-interleukin (IL)-12, anti-IL-23, and anti-TNF agents was associated with a lower adjusted rate of serious adverse events (SAEs) than time off those drugs.

METHODOLOGY:

• Researchers analyzed 11,641 older adults aged ≥ 66 years with psoriasis or PsA who received their first systemic medication between April 2002 and December 2020 in Ontario, Canada.
• Medication exposure was categorized into six groups: methotrexate, other older systemic medications, anti-TNF, anti‑IL‑12/23, anti‑IL‑17, and tofacitinib.
• The analysis included 68,344 person-years of follow-up until March 31, 2021, with participants contributing person-time on and off different medication classes.
• Primary outcome measure was SAEs, defined as a composite of all-cause emergency department visits and hospitalizations.

TAKEAWAY:

• A total of 42,553 SAEs were reported over 68,344 person-years of follow-up; 76% of the patients experienced at least one SAE.
• The use of anti-IL-12 and anti-IL-23 biologics (relative rate [RR], 0.83; 95% CI, 0.75-0.91) and anti-TNF agents (RR, 0.93; 95% CI, 0.88-0.99) was associated with the lower adjusted rate of SAEs than time off these agents.
• Other older systemic medications (including cyclosporine, acitretin, sulfasalazine, and leflunomide) were associated with a modestly higher adjusted rate of SAEs (RR, 1.07; 95% CI, 1.03-1.12), whereas methotrexate and anti-IL-17 agents showed no significant increase in adjusted risk.
• Hospitalization rates were lower for methotrexate (RR, 0.94; 95% CI, 0.89-0.99), anti-TNF agents (RR, 0.77; 95% CI, 0.67-0.87), and anti-IL-12 or anti-IL- 23 biologics (RR, 0.72; 95% CI, 0.61-0.85).

IN PRACTICE:

“In this population-based study of older adults with psoriasis and PsA prescribed systemic treatments, biologics inhibiting IL-12 and/or [IL]-23 were associated with the lowest rates of SAEs,” the authors concluded. The data, they added, “provide further reassurance about the relative safety of anti-IL-12 and [anti-IL]-23 biologics among older adults.”

SOURCE:

The study was led by Aaron Drucker, University of Toronto, Toronto, Ontario, and was published online on November 15 in the Journal of Investigative Dermatology.

LIMITATIONS:

The limitations were possible residual confounding, lack of head-to-head comparisons, and nonspecific SAE as outcome which could include AEs not related to drugs.

DISCLOSURES:

The study was supported by grants from the Canadian Institutes of Health Research, Institute for Clinical Evaluative Sciences, and Canada Research Chair in Drug Policy and Substance Use. Drucker disclosed receiving research grants and compensations from various medical journals and organizations, including the British Journal of Dermatology, American Academy of Dermatology, Canadian Dermatology Today, Canadian Agency for Drugs and Technologies in Health, National Eczema Association, Eczema Society of Canada, Canadian Dermatology Foundation, Canadian Institutes for Health Research, US National Institutes of Health, and Physicians Services Incorporated Foundation. Several other authors also reported receiving research grants, honoraria, consulting fees, and payments from various drug companies, medical journals, and organizations. All disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.