Biologic Treatment in Elderly Patients with Psoriasis: Focus on Safety and Adherence

Introduction The number of elderly psoriasis patients is increasing, yet data on biological treatments in this population remains limited. Objectives To evaluate the characteristics, efficacy, and safety of biologics in psoriasis patients aged ≥65 years and identify factors contributing to treatment interruption or discontinuation. Methods The study included psoriasis patients aged ≥65 years who had received at least one biological treatment at a tertiary center for a minimum of 24 weeks between 2022 and 2024. Demographic and clinical data, treatment history, PASI scores, adverse events, and reasons for treatment interruption or discontinuation were evaluated. Results Among 231 patients on biologics, 43 (18.6%) were aged ≥65 years (mean age: 70.2 ± 4.8 years, male-to-female ratio: 2:1). Mean PASI scores improved from 14.5 ± 8.8 at baseline to 1.5 ± 1.5 at weeks 12-16, and to 0.83 ± 1.2 at week 52. Latent tuberculosis and anti-HBc positivity were common (65.1% and 51.2%, respectively), but no reactivation occurred. Adverse events were reported in 39.5% of patients, most commonly infections (27.9%). Treatment-ending events occurred in 7.0%, all due to malignancies. Treatment interruptions occurred in 20.9%, mainly due to noncompliance, transportation difficulties, and comorbidities. Notably, 20.9% of the patients required assistance to attend their hospital visits, and 44.2% required help administering their drug. Treatment was discontinued in 16.3%, primarily due to malignancies and secondary failure. Conclusions Biologics are effective in psoriasis patients aged ≥65 years. A relatively high malignancy rate emphasizes the importance of age-appropriate screening. Noncompliance, comorbidities, transportation problems, and healthcare access barriers may pose challenges in long-term treatment maintenance.