Biologic Treatment in Elderly Patients With Psoriasis: A Systematic Review.

With our aging population, an increasing number of psoriasis patients are classified as elderly. However, psoriasis treatment in older adults can be challenging, given an increased number of comorbid conditions and immunosenescence. Biologic agents present a solution to this treatment dilemma because of their high efficacy and favorable tolerability. The objective of this systematic review was to summarize the findings of clinical trial and real-world studies exploring the safety and efficacy of biologic agents in elderly patients with moderate-to-severe psoriasis. We searched MEDLINE, Embase, the Cochrane Library, and clinical trial databases. Studies analyzing biologics for psoriasis were included if elderly patients were the main population of interest or were a separate subgroup in their analysis. Eighteen articles met inclusion criteria after screening. Across all biologic classes, efficacy for biologics between nonelderly adult patient and elderly patients was similar. Adverse events (AEs) and infections occured at a similar frequency between both groups. However, serious AEs were more common in the elderly. The available literature on the safety and efficacy of biologic agents in elderly patients supports the use of these agents in this population. However, serious AEs and discontinuation due to AEs were more common in older patients. As elderly patients have a higher burden of comorbid conditions and an increased baseline vulnerability for AE, physicians should continue to be prudent in screening before initiating biologics and monitor patients more closely as AEs tend to be more severe.

The role of anti-tumour necrosis factor in wound healing: A case report of refractory ulcerated necrobiosis lipoidica treated with adalimumab and review of the literature.

Necrobiosis lipoidica is a chronic granulomatous disease historically associated with diabetes. Necrobiosis lipoidica commonly presents with erythematous papules or plaques on the anterior lower extremities, which can be ulcerated in up to 30% of patients. The pathophysiology of necrobiosis lipoidica is unknown but proposed to be predominantly linked to microangiopathy. No treatment option for necrobiosis lipoidica has shown consistent efficacy. Previous case reports have shown immune-modulating agents to be reasonable treatment options for ulcerative necrobiosis lipoidica. However, evidence for the tumour necrosis factor-alpha inhibitor, adalimumab, is limited and contradictory. We report a case of a 74-year-old type 2 diabetic female with a 2-year history of multiple ulcerated necrobiosis lipoidica plaques resistant to topical and systemic therapy. Treatment with adalimumab showed complete re-epithelization of all ulcers by week 28. Adalimumab may be an effective treatment option for ulcerated necrobiosis lipoidica that has failed traditional therapies. Further reports of adalimumab treatment of necrobiosis lipoidica and other chronic inflammatory wounds are needed.