Real-world data have demonstrated that differences exist in some patient characteristics between individuals with early-onset psoriasis (EOP) and patients with late-onset psoriasis (LOP). In fact, individuals with EOP are less likely than individuals with LOP to respond to certain systemic therapies, according to the results of the Psoriasis Longitudinal Assessment and Registry study (ClinicalTrials.gov identifier: NCT00508547), which were published in the American Journal of Clinical Dermatology.
The investigators sought to compare the therapeutic response among patients with EOP vs patients with LOP who were being treated with adalimumab, etanercept, infliximab, ustekinumab, or methotrexate. The participants were grouped according to age of disease onset: EOP (≤40 years) or LOP (>40 years). The adjusted odds ratios (aORs) for achieving a Physician’s Global Assessment score of clear/minimal (Physician’s Global Assessment score 0/1) or a percentage of body surface area (BSA) involved with psoriasis <3% (%BSA <3) or <1% (%BSA <1) for all participants were calculated.
A total of 7511 patients were enrolled in the study, of whom 72.9% (5479 of 7511) had EOP. Among all patients, the LOP group had a significantly greater likelihood of achieving a Physician’s Global Assessment score 0/1 after treatment compared with the LOP group (aOR, 1.14; 95% CI, 1.05-1.25; P =.0019). The same was true in all subgroups of patients treated with methotrexate (aOR, 1.62; 95% CI, 1.16-2.26; P =.0049) and patients treated with etanercept (aOR, 1.38; 95% CI, 1.14-1.66; P =.0010).
Among all participants, no significant difference was reported between the EOP and LOP groups with respect to the chance of attaining %BSA <3 or %BSA <1. Participants in the LOP group were significantly more likely than participants in the EOP group to achieve %BSA <3 or %BSA <1 among patients treated with infliximab (aOR, 1.45; 95% CI, 1.09-1.93; P =.0103 or aOR, 1.36; 95% CI, 1.03-1.78; P =.0290, respectively) and patients treated with etanercept (aOR, 1.30; 95% CI, 1.06-1.61; P =.0123 or aOR, 1.34; 95% CI, 1.09-1.64; P =.0053, respectively).
The investigators concluded that patients with LOP who are treated with etanercept, infliximab, or methotrexate are significantly more likely than patients with EOP to experience a therapeutic response. Results of the study did not demonstrate any difference in treatment outcomes, however, among patients treated with ustekinumab or adalimumab.
Singh S, Kalb RE, de Jong EMGJ, et al. Effect of age of onset of psoriasis on clinical outcomes with systemic treatment in the Psoriasis Longitudinal Assessment and Registry (PSOLAR). Am J Clin Dermatol. 2018;19(6):879-886.