Anti-interleukin-23 for psoriasis in elderly patients: guselkumab, risankizumab and tildrakizumab in real-world practice.

BACKGROUND: Elderly patients (aged ≥ 65 years) represent an increasing proportion of patients with psoriasis and 15% of these have moderate to severe disease. Biologics are being used frequently in this group of patients even though safety and efficacy data are limited. In addition, owing to anti-interleukin (IL)-23 therapies being a relatively recent option, no data have been reported about their use in elderly patients with psoriasis. AIM: To evaluate and compare the safety and efficacy of guselkumab, risankizumab and tildrakizumab in real-world practice in elderly patients. METHODS: This was a single-centre retrospective study that enrolled patients aged ≥ 65 years with moderate to severe plaque psoriasis, treated with guselkumab, risankizumab or tildrakizumab. The length of the study for each group depended on the drug (44 weeks for risankisumab, 40 weeks for guselkumab and 28 weeks for tildrakizumab, owing to its more recent availability in Italy). RESULTS: In total, 34 patients were enrolled (n = 20 on guselkumab; n = 8 on risankizumab; n = 6 on tildrakizumab). At Week 4, 29.4% reached 90% improvement in Psoriasis Area and Severity Index (PASI90) and 8.8% reached 100% improvement in PASI (PASI100); at Week 28, PASI90 and PASI100 was reached by 58.8% and 29.4%, respectively. At the final follow-up (Week 40 or 44, depending on drug), data were available only for the risankizumab (Week 40) and guselkumab (Week 44) and groups, and showed that 71.4% of patients had reached PASI90 and 53.5% had reached PASI100. Four patients (11.7%) discontinued treatment. No significant differences were found between the three groups. The limitations of the study included its retrospective nature of the study, small sample size, and different numbers of patients and follow-up duration for the different groups (highest for guselkumab, lowest for tildrakizumab). CONCLUSION: The three anti-IL-23 therapies assessed are promising, safe and effective options in elderly patients, and there was no significant difference between them. However, more data are needed to confirm our results and to understand their role in the management of this group of patients.

Real-life efficacy and safety of secukinumab in elderly patients with psoriasis over a 2-year period.

BACKGROUND: The prevalence of psoriasis is increasing among older people. Elderly patients with psoriasis represent a challenge for dermatologists owing to multiple comorbidities, polypharmacy and immune senescence, which lead to an increased possibility of adverse events (AEs), drug interactions and susceptibility to cancers and infections. Therefore, conventional systemic therapies are often contraindicated, with biologics appearing as the mainstay for moderate-to-severe disease. However, the data on efficacy and safety of biologics in older people are scant. AIM: To evaluate the efficacy and safety of secukinumab in elderly patients with psoriasis over a 2-year period. METHODS: A real-life retrospective observational study was performed on patients aged ≥ 65 years with moderate-to-severe plaque psoriasis who were treated with secukinumab at the Psoriasis Care Unit of the University of Naples Federico II, Italy from June 2016 to June 2019. RESULTS: Mean Psoriasis Area Severity Index (PASI) reduced from 11.4 ± 6.3 at baseline to 2.1 ± 1.7 at week 24 and 1.7 ± 1.9 at week 96 (P < 0.001 for all follow-up visits), with a final mean PASI reduction of 85.1%. A similar trend was noted for body surface area (BSA), with baseline value of 27.5 ± 15.7 decreasing to 6.8 ± 5.0 at week 24, and to 3.3 ± 2.5 at week 96 (P < 0.001 at all follow-up visits), with a final mean BSA score reduction of 88.0%. Registered AEs did not lead to secukinumab discontinuation, except in one patient (3.4%). CONCLUSION: Secukinumab seems to be a safe and effective treatment for elderly patients with psoriasis, who frequently have multiple comorbidities, polypharmacy and multiple failures with previous systemic treatments including biologics.

Ultrasonographic characteristics of accessory sex glands and spectral Doppler indices of the internal iliac arteries in peri- and post-pubertal Dorper rams raised in a subtropical climate.

The aim of the present study was to determine and compare ultrasonographic characteristics of accessory sex glands and spectral Doppler indices of the internal iliac arteries in peri- and post-pubertal rams raised in a subtropical climate. Forty-five Dorper rams were examined (24 rams aged 8-11 months and 21 rams aged 12-24 months). Digital images of all accessory sex glands were subjected to morphometric and echotextural analyses, the latter using commercially available image analytical software Image ProPlus®. Physical and morphological characteristics of semen and serum concentrations of testosterone were also determined. The dimensions of the prostate gland (12.9±1.2 compared with 14.2±2.7mm; mean±standard deviation) and bulbourethral glands (13.7±1.3 compared with 14.7±1.8mm) were greater (P=0.04) in sexually mature compared with peri-pubertal rams. Pixel intensity of vesicular (181.5±20.8 compared with 164.8±26.8, P=0.02) and bulbourethral gland parenchyma (166.9±16.9 compared with 141.8±29.1, P=0.001) was greater in peri-pubertal compared with sexually mature rams. Semen could be collected by ejaculation into the artificial vagina from 38% (8/21) of post-pubertal rams and 21% (5/24) of peri-pubertal animals (P=0.03). Semen volume was positively correlated with peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the internal iliac arteries (r=0.79, P=0.001 and r=0.67, P=0.01, respectively), while spermatic vigor and progressive motility were inversely related to circulating concentrations of testosterone (r=-0.69, P=0.009 and r=-0.61, P=0.03, respectively). In summary, the attainment of sexual maturity in the rams of the present study was associated with an enlargement of the prostate and bulbourethral glands, and with the shift in echotextural attributes of vesicular and bulbourethral glands. Circulating testosterone concentrations and Doppler blood flow indices of the ram's internal iliac arteries are significant predictors of sperm progressive motility, vigor and the amount of ejaculate.