Comorbidity Burden in Psoriasis Patients with Skin of Color.

Background: Psoriasis is a chronic disease with increased risk of numerous comorbidities. Known differences exist regarding treatment outcomes for psoriasis patients with skin of color (SOC). However, factors contributing to these differences are relatively unknown. Objectives: This study aims to compare the comorbidity burden in SOC psoriasis patients vs. White patients, as measured by the Charlson Comorbidity Index (CCI) score. Methods: We utilized the National Ambulatory Medical Care Survey (NAMCS) to identify visits for adult psoriasis patients occurring in the years 2002-2016 and 2018. The CCI was used to objectively measure comorbidity burden. Patients were identified by race, and SOC was defined as any reported race besides White Only. A multiple linear regression was run to compare the CCI among adult psoriasis patients based on race and ethnicity, controlling for age, sex, insurance status, and geographic region. Results: A total of 39,176,928 weighted visits were analyzed. Compared to White patients, patients with SOC did not have statistically significant differences in comorbidity burden, as measured by CCI score (p=0.073 for Black/African American Only vs. White Only, p=0.073 for American Indian/Alaska Native Only vs. White Only, p=0.435 for Asian Only vs. White Only, p=0.403 for Native Hawaiian/Pacific Islander Only vs. White Only, p=0.195 for Other vs. White Only). Conclusion: Patients with SOC were not found to have differences in comorbidity burden compared to White patients. These results highlight that social factors such as socioeconomic status and access to healthcare may contribute more directly to psoriasis treatment outcomes than patient race.

Prologue: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2022 Annual Meeting.

The 2022 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held from July 14 to 17, 2022, in New York City, New York, USA, and was attended by 420 rheumatologists, dermatologists, basic scientists, allied health professionals, patient research partners, and industry partners from 31 countries. A GRAPPA executive retreat, a Trainee Symposium, and the Patient Research Partners Network meeting were held prior to the annual meeting. Presentations included updates in basic research, focusing on biomarkers, personalization of treatments, and the promise of single-cell omics, elucidating the pathogenesis of psoriatic disease (PsD). Presentations also highlighted guttate and plaque psoriasis (PsO), the impact of coronavirus disease 2019 (COVID-19) and its treatments on patients with PsD globally, and the effects of sex and gender in PsD. Reports of ongoing projects included an update on the recently published treatment recommendations, educational initiatives, and the Diagnostic Ultrasound Enthesitis Tool (DUET) study. A session on early identification of psoriatic arthritis (PsA) among patients with PsO included an update on PsA screening tools. Debates were held on whether early intervention for PsO will reduce PsA, whether interleukin (IL)-17 or IL-23 inhibition is a better treatment for PsO and PsA, similarities and differences between axial PsA and axial spondyloarthritis with PsO, and data affecting the understanding of guttate and plaque PsO. Reports from the International Dermatology Outcome Measures (IDEOM) and Young GRAPPiAns concurrent sessions were presented in addition to reports of several other partner groups. Here, we highlight features of the annual meeting and introduce the manuscripts published together as a meeting report.

Patient Perspectives on Psoriatic Disease Burden: Results from the Global Psoriasis and Beyond Survey.

BACKGROUND: Patients' understanding of the systemic nature of psoriatic disease (PsD) remains insufficiently explored. OBJECTIVES: The objective of this study was to assess patients' understanding of PsD, associated comorbidities, disease burden, and relationships with healthcare professionals (HCPs). METHODS: Psoriasis and Beyond was a cross-sectional, quantitative online survey conducted in patients with a self-reported, physician-given diagnosis of moderate to severe psoriasis (body surface area [BSA] >5% to <10%, affecting sensitive and/or prominent body parts or BSA ≥10%) at its worst, with/without psoriatic arthritis (PsA). Patients were recruited through online panels by the Institut de Publique Sondage d'Opinion Secteur (Ipsos SA) and patient advocacy groups. RESULTS: Overall, 4,978 respondents with psoriasis completed the online survey from 20 countries across Australia, Asia, Europe, and the Americas; 30% of patients also reported having concomitant PsA. Overall, 69% of patients with psoriasis had heard that their disease was part of a systemic disease, and 60% had heard of the term "psoriatic disease." Despite this, recognition of common manifestations and comorbidities associated with PsD was low. Among psoriasis-only patients (n = 3,490), 38% screened positive using the Psoriasis Epidemiology Screening Tool (PEST), indicative of potential PsA. Overall, 48% of patients reported that their disease had a very large to extremely large effect on quality of life (QoL; Dermatology Life Quality Index [DLQI] score, 11-30); only 13% of patients reported no impact of the disease on QoL (DLQI, 0-1). Most patients had experienced stigma and discrimination (82%) and a negative impact on relationships (81%) in their lives. Overall, 59% of patients were not involved in deciding their treatment goals: 58% of all treated patients (n = 4,757) and 64% of treated patients with concomitant PsA (n = 1,409) were satisfied with their current treatment. CONCLUSIONS: These results highlight that patients may not fully understand the systemic nature of their disease, were frequently uninvolved in deciding treatment goals, and were often not satisfied with their current treatment. Increasing patients' participation in their care can facilitate shared decision-making between patients and HCPs, which may result in better treatment adherence and patient outcomes. Furthermore, these data indicate that policies should be implemented to protect against stigma and discrimination, which are commonly experienced by patients with psoriasis.

Perspectives on nonmedical switching and the COVID-19 pandemic: a narrative review.

OBJECTIVES: Nonmedical switching (NMS) is a change in a patient's treatment regimen for reasons other than lack of efficacy, intolerance, adverse effects, or poor adherence. We describe the impact of NMS on patients, health care workers, and health systems, focusing on NMS to in-class biologic alternatives in US patients with chronic, immune-mediated rheumatic and dermatologic conditions. Additionally, we evaluate the ways in which the COVID-19 pandemic may exacerbate the physical, psychological, and economic impacts of NMS. STUDY DESIGN: Narrative review. METHODS: We performed a search of MEDLINE's PubMed database from October 2015 to October 2020, with a repeat search in October 2021. Search terms included relevant keywords pertaining to NMS, biologics, and disease areas. Results were supplemented by a search of key congress abstracts from 2015 to 2021 and a targeted internet search. RESULTS: NMS increases medication abandonment, errors, and adverse effects, and it can lead to longer patient visits, increased follow-up visits, additional laboratory tests and procedures, and greater overall health care resource utilization (HCRU). The increased HCRU associated with NMS increases patients' financial burden due to additional co-pays and out-of-pocket costs. CONCLUSIONS: The decision to switch treatments should result from shared decision-making between health care providers (HCPs) and patients to achieve the best clinical outcomes and optimal HCRU. The issues related to NMS may be compounded by the financial and psychosocial stress on HCPs and patients created by the COVID-19 pandemic. HCPs should advocate for continuous patient treatment and be familiar with continuity of care legislation, appeals processes, and manufacturer assistance programs.

Cost-effectiveness of tildrakizumab for the treatment of moderate-to-severe psoriasis in the United States.

OBJECTIVE: To evaluate the relative cost-effectiveness of tildrakizumab and other biologic and targeted systemic treatments compared with a mix of topical therapies, phototherapies, and other conventional systemic therapies as first-line treatment for moderate-to-severe plaque psoriasis from a United States payer's perspective. METHODS: A Markov model consisting of health states based on Psoriasis Area Severity Index (PASI) response rate categories and death was developed. The probabilities of achieving PASI responses were derived from a network meta-analysis based on published efficacy data. Health care costs and effectiveness measured in quality-adjusted life-years (QALYs) were estimated. Incremental costs per QALY gained of each biologic/targeted first-line treatment versus a mix of conventional treatments were compared to provide relative cost-effectiveness among biologic and targeted first-line treatments. RESULTS: Over 10 years, the incremental cost per QALY gained compared with a mix of topical therapies, phototherapies, and other oral systemic therapies was lowest for brodalumab, infliximab, apremilast, and tildrakizumab, followed by secukinumab, ixekizumab, guselkumab, adalimumab, ustekinumab, and etanercept. The position of tildrakizumab relative to the other treatments remained the same across multiple scenarios. CONCLUSIONS: Tildrakizumab is among the most cost-effective first-line therapies for moderate-to-severe plaque psoriasis and is more cost-effective than secukinumab, ixekizumab, guselkumab, adalimumab, ustekinumab, and etanercept.

Differences in health care resource utilization and costs for keratinocyte carcinoma among racioethnic groups: A population-based study.

BACKGROUND: As the United States becomes more diverse, determining differences in health care utilization and costs in the management of skin cancers is fundamental to decision-making in health care resource allocation and improving care for underserved populations. OBJECTIVE: To compare health care use and costs among non-Hispanic White, Hispanic White, and non-Hispanic Black patients with keratinocyte carcinoma. METHODS: A nationwide cross-sectional study was performed using Medical Expenditure Panel Survey data from 1996 to 2015. RESULTS: Among 54,503,447 patients with keratinocyte carcinoma (weighted) over a 20-year period, 53,134,351 (97%) were non-Hispanic White; 836,030 (1.5%) were Hispanic White; and 170,755 (0.3%) were non-Hispanic Black. Compared to non-Hispanic White patients, Hispanic White patients had significantly more ambulatory visits per person per year (5.4 vs 3.5, P = .003). Compared to non-Hispanic White patients, non-Hispanic Black patients had significantly more ambulatory visits (13.1 vs 3.5, P = .027) and emergency department visits (2.3 vs 1.1, P < .001), and incurred significantly higher ambulatory costs ($5089 vs $1131, P = .05), medication costs ($523 vs $221, P = .022), and total costs per person per year ($13,430 vs $1290, P = .032). LIMITATIONS: Data for squamous cell carcinomas and basal cell carcinomas are combined. CONCLUSIONS: Keratinocyte carcinoma was more costly to treat and required more health care resources in non-Hispanic Black and Hispanic White patients than in non-Hispanic White patients.

Language proficiency and biologics access: a population study of psoriasis patients in the United States.

BACKGROUND: Language proficiency plays an important role in healthcare choices and access. Differences in access to biologic medications exist, but it is unknown how much English proficiency influences access in US psoriasis patients. OBJECTIVE: To compare biologic medication use for psoriasis patients with differing English proficiency levels. METHODS: Population study of US psoriasis patients using the 2013-2017 Medical Expenditure Survey. RESULTS: Among a total of 4,470,820 US psoriasis patients (weighted), 4,028,119 (90.1%) had perfect English proficiency, and 442,700 (9.9%) had less than perfect English proficiency. Among the total population, 422,523 (9.5%) had access to biologics. Among those who received biologics, 411,411 (97.4%) of those had perfect English proficiency, and 11,112 (2.6%) of those had less than perfect English proficiency. Multivariate logistic regression found that patients with less than perfect English proficiency were significantly less likely to have access to biologics [OR 0.015 (95% CI: 0.001-0.179); p = .002], after adjusting for insurance status, income, education, healthcare utilization, and other sociodemographic and clinical factors. LIMITATIONS: Psoriasis disease severity not specified. CONCLUSIONS: Psoriasis patients with low English proficiency are significantly less likely to receive biologics than those with high English proficiency. Those with higher English proficiency are 61 times more likely to access biologics.

Does location matter? Geographic variations in healthcare resource use for atopic dermatitis in the United States.

BACKGROUND: It is unknown which region of the U.S. offers the best and worst access to care for atopic dermatitis (AD). METHODS: We conducted a cross-sectional study using the Medical Expenditure Panel Survey (MEPS) from 1996 to 2015 to compare healthcare resource use and cost of AD among U.S. census regions. We conducted multivariable regression analyses adjusting for clinicodemographic factors to evaluate regional differences in healthcare resource use and cost per patient per year (PPPY) in terms of ambulatory visits, ED visits, and medications directly attributable to AD. RESULTS: An estimated total of 6,348,578 (95% CI: 5,944,553-6,752,803) AD patients (weighted) were pooled. Compared to the remainder of the country, Midwest AD patients utilized the fewest ambulatory visits (0.55 versus 0.75 visits PPPY; p = .035). The proportion of patients with ≥1 ED visits was highest in the Midwest (7.1%), followed by the South (5.4%), Northeast (4.8%), and West (1.4%). Within the Midwest AD population, those with no ambulatory visits per year utilized nearly three times more ED visits when compared with those with one or more ambulatory visits per year (0.11 versus 0.04 visits PPPY; p = .019). CONCLUSION: Our results suggest that Midwest AD patients have differential access to outpatient care, which may be resulting in higher ED usage.

Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures.

Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.

National Psoriasis Foundation COVID-19 Task Force Guidance for Management of Psoriatic Disease During the Pandemic: Version 1.

OBJECTIVE: To provide guidance about management of psoriatic disease during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: A task force (TF) of 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care was convened. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation (NPF) staff. Clinical questions relevant to the psoriatic disease community were informed by questions received by the NPF. A Delphi process was conducted. RESULTS: The TF approved 22 guidance statements. The average of the votes was within the category of agreement for all statements. All guidance statements proposed were recommended, 9 with high consensus and 13 with moderate consensus. LIMITATIONS: The evidence behind many guidance statements is limited in quality. CONCLUSION: These statements provide guidance for the management of patients with psoriatic disease on topics ranging from how the disease and its treatments impact COVID-19 risk and outcome, how medical care can be optimized during the pandemic, what patients should do to lower their risk of getting infected with severe acute respiratory syndrome coronavirus 2 and what they should do if they develop COVID-19. The guidance is intended to be a living document that will be updated by the TF as data emerge.

Investigator and Patient Global Assessment Measures for Psoriasis Clinical Trials: A Systematic Review on Measurement Properties from the International Dermatology Outcome Measures (IDEOM) Initiative.

BACKGROUND AND OBJECTIVE: The International Dermatology Outcome Measures (IDEOM) has defined a core set of domains to be measured in all psoriasis clinical trials. This set comprises the following domains: skin manifestations, psoriasis and psoriatic arthritis symptoms, health-related quality of life, investigator global, patient global, and treatment satisfaction. The next step is to define how to measure these domains. The objective of this article was to evaluate the quality of available instruments to assess 'investigator global' and 'patient global' domains to identify the most appropriate instruments. METHODS: Reviewers conducted a systematic literature review to retrieve studies on the measurement properties of instruments including either an investigator global assessment or a patient global assessment. Following the COnsensus based standards for the Selection of health Measurement INstruments (COSMIN) checklist, three independent reviewers rated the quality of each study. We then performed a qualitative synthesis of the evidence. RESULTS: We identified nine investigator global assessments and three patient global assessments, reflecting substantial variability in global assessment instruments. Overall, most measures lacked evidence for content validity and feasibility. The Lattice System-Physician Global Assessment, Product of the Investigator Global Assessment and Body Surface Area, and the professional-Simplified Psoriasis Index had higher levels of evidence for validity, reliability, and/or responsiveness than the 5- and 6-point investigator global assessments. The self-assessment-Simplified Psoriasis Index was the only patient global assessment with evidence for validity, reliability, and responsiveness. CONCLUSIONS: The 5- and 6-point investigator global assessments, which are the most widely used investigator global assessments in registered clinical trials, have less evidence for measurement properties as compared with the Lattice System-Physician Global Assessment, professional-Simplified Psoriasis Index, and the Product of the Investigator Global Assessment and Body Surface Area. However, all instruments lack evidence for content validity and feasibility. Further validation studies of investigator global assessments and patient global assessments are required to recommend the best global measure for psoriasis clinical trials.

Where you live matters: Regional differences in health care resource use for psoriasis in the United States.

BACKGROUND: It is unknown which U.S. Census region offers the best access to health care resources. OBJECTIVE: To compare health care resource use and costs for patients with psoriasis among the 4 U.S. Census regions. METHODS: Cross-sectional study using the 1996-2015 Medical Expenditure Panel Survey. RESULTS: In the United States the greatest access for biologic medications was in the South (9.1% receiving biologic medications/year), followed by the Northeast (7.4%), the West (6.8%), and the Midwest (5.2%). Ambulatory visits per patient per year were highest in the West (5.02), followed by the Northeast (3.81), the South (2.95), and the Midwest (2.84). The proportion of patients with ≥1 emergency department (ED) visits was highest in the Northeast (2.73%), followed by the West (2.17%), the South (1.19%), and the Midwest (1.17%). Compared with the remainder of the country, the West incurred the lowest total health care costs (P = .035) and the lowest drug costs (P = .023); and the Northeast incurred the highest total health care costs (P = .050) and the highest ambulatory costs (P < .001). Although the South had the greatest proportion of patients using biologic medications (9.1% vs 6.4%, P = .045), it also had 30% fewer ambulatory visits per patient per year and a 39% lower proportion of ED visits for psoriasis. LIMITATIONS: Data for psoriasis severity were unavailable. CONCLUSIONS: Southern U.S. states have the greatest access to biologic medications and incurred fewer ambulatory and ED visits. The Midwest had the lowest access to biologic medications and ambulatory and ED care. The West incurred the lowest total health care costs, while the Northeast incurred the highest total health care costs.

Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy.

Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world's population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet (UV) light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, targeted UVB treatments such as with an excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye lasers, intense pulse light, and light-emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.

Economic burden of cutaneous infections in children and adults with atopic dermatitis.

BACKGROUND/OBJECTIVES: Atopic dermatitis (AD) is a chronic, inflammatory disease affecting both children and adults. AD is associated with multiple comorbidities and complications. In particular, AD patients are susceptible to developing cutaneous infections. Studies show that comorbidities have contributed significantly to increased health care utilization and costs in AD. However, evidence regarding the degree to which this increased health care utilization and expenditure in AD is attributable to cutaneous infections is lacking. The aim of this study was to assess the impact of skin infections on health care utilization and expenditures among patients with atopic dermatitis. METHODS: This cross-sectional study examined health care utilization and expenditures for AD patients of all ages with and without skin infections in the United States using the nationally representative 1996-2015 Medical Expenditure Panel Survey (MEPS) data. RESULTS: In this study, a total of 4 825 668 (weighted) patients had a diagnosis of AD (mean age 5.7). Of these, 776 753 patients (16%) experienced skin infections (mean age 4.4). Compared to AD patients without skin infections, those with skin infections had more frequent visits to ambulatory clinics (P = 0.001) and the emergency department (P = 0.011), and increased hospitalization (P = 0.010), after adjustments for demographic and clinical factors. AD patients with skin infections were also given 3.3 more prescriptions (P < 0.0001). AD patients with skin infections incurred significantly greater health care costs, which included an additional $351/patient/year for ambulatory visits (P < 0.0001) and an additional $177/patient/year for prescription medications (P < 0.0001). CONCLUSIONS: Atopic dermatitis patients with cutaneous infections incurred significantly greater health care utilization and expenditures than those without cutaneous infections.

Real-world utilization patterns of systemic immunosuppressants among US adult patients with atopic dermatitis.

At the time of this study, prior to the introduction of biologics in the US, systemic therapies used for the treatment of moderate-to-severe atopic dermatitis included off-label immunosuppressants and corticosteroids. Immunosuppressant therapy is associated with a substantial risk of side-effects, therefore needing clinical monitoring, and is likely to incur a significant healthcare burden for patients and payers. This retrospective cohort study based on claims data measured immunosuppressant use and its associated burden among US adult patients with atopic dermatitis covered under commercial or Medicare Supplemental insurance from January 01, 2010, to September 30, 2015. Overall, based on age, gender, region, and index year, 4201 control patients with atopic dermatitis without immunosuppressant use were matched with 4204 patients treated with immunosuppressants. The majority (68.5%) of patients using immunosuppressants were non-persistent with immunosuppressant treatment during the 12-month follow-up period after a mean (standard deviation) of 88.1 (70.7) days of immunosuppressant use; 72.3% required systemic steroid rescue treatment. Immunosuppressant users had higher incidence of immunosuppressant-related clinical events than controls; in addition, a larger proportion of immunosuppressant users versus controls developed cancer (0.28% vs 0.14%, respectively; P < 0.0001). Healthcare utilization and costs associated with clinical events and monitoring were also higher for immunosuppressant users compared with controls (total costs, $9516 vs $1630, respectively; P < 0.0001; monitoring costs, $363 vs $54, respectively; P < 0.0001). This study revealed that patients treated with systemic immunosuppressants often require systemic steroids or changes to treatment. The increase in immunosuppressant-related clinical events, including the need for increased monitoring with immunosuppressant treatment, compared with controls demonstrates a substantial treatment burden and highlights the unmet need for more effective long-term therapies for atopic dermatitis with improved safety profiles and reduced monitoring requirements.

Access to Dermatological Care with an Innovative Online Model for Psoriasis Management: Results from a Randomized Controlled Trial.

Background:Many patients with chronic skin diseases lack regular access to dermatologists in the United States and suffer poor clinical outcomes.Introduction:We performed a 12-month randomized controlled trial to evaluate the impact of an online, collaborative connected health (CCH) model for psoriasis management on access to specialty care.Materials and Methods:The 300 enrolled patients were randomized to online or in-person care. We compared distance traveled as well as transportation and in-office waiting time between the two groups and obtained patient and provider perspectives on CCH.Results:At baseline, no differences existed between the groups in difficulties obtaining specialty care. Over 12 months, the mean (standard deviation [SD]) distance traveled to and from appointments was 174.8 (±577.4) km/person for the in-person group and 2.2 (±14.2) km/person for the online group (p = 0.0003). The mean (SD) time spent on transportation and in-office waiting for in-person appointments was 4.0 (±4.5) h/person for the in-person group and 0.1 (±0.4) h/person for the online group (p = 0.0001). Patients found CCH to be safe, accessible, equitable, efficient, effective, and patient-centered. Providers found CCH to be useful for providing psoriasis care.Discussion:The CCH model resulted in significantly less distance traveled as well as transportation and in-office waiting time compared to in-person care. Both patients and providers were highly satisfied with CCH.Conclusions:The CCH model resulted in increased access to specialty care and enabled patient-centered, safe, and effective management of psoriasis patients.

A provider global assessment quality measure for clinical practice for inflammatory skin disorders.

In our evolving health care system, dermatologists are increasingly being asked to prove the value of care they provide to patients with severe skin diseases. Current quality measures for inflammatory dermatoses have limited validity and feasibility. Through collaboration and a modified Delphi process, International Dermatology Outcome Measures and the American Academy of Dermatology sought to reach consensus on a valid and feasible provider-assessed global disease severity metric to be incorporated into a quality measure for inflammatory dermatoses. To inform the modified Delphi process, a review of the literature was performed, and data were collected on current provider-assessed global disease severity metrics. After literature review, 36 members of International Dermatology Outcome Measures and the American Academy of Dermatology participated in the modified Delphi process to reach consensus on features of the metric. Psoriasis, atopic dermatitis, and acne achieved overwhelming consensus for inflammatory dermatoses that could be measured in a global disease severity metric. Consensus was also reached on the use of a 5-point ordinal scale with descriptors provided through referenced electronic platforms. Expert development of quality measures incorporating this metric and its inclusion in data collection platforms are critical to enabling dermatologists to prove the value of care provided to patients with severe inflammatory dermatoses.

Effect of Age of Onset of Psoriasis on Clinical Outcomes with Systemic Treatment in the Psoriasis Longitudinal Assessment and Registry (PSOLAR).

OBJECTIVE: Our objective was to compare therapeutic response among patients with early-onset psoriasis (EOP) and late-onset psoriasis (LOP) receiving adalimumab, etanercept, infliximab, ustekinumab, or methotrexate in the Psoriasis Longitudinal Assessment and Registry (PSOLAR). METHODS: Patients were grouped by age of onset: EOP (age ≤ 40 years) or LOP (age > 40 years). Repeated-measures analysis with logistic regression was used to calculate the adjusted odds ratio (AOR; adjusted for baseline characteristics) for achieving a Physician's Global Assessment score of cleared/minimal (PGA 0/1) or a percentage of body surface area involved with psoriasis < 3% (%BSA < 3) or %BSA < 1 for all patients; similar sensitivity analyses were performed for each treatment group. RESULTS: Of 7511 patients, 5479 (72.9%) had EOP. The LOP group had a higher likelihood of achieving PGA 0/1 after treatment than did the EOP group in all patients (AOR 1.14 [95% confidence interval (CI) 1.05-1.25]; p = 0.0019); the same was true in subgroups of etanercept-treated (AOR 1.38 [95% CI 1.14-1.66]; p = 0.0010) and methotrexate-treated (AOR 1.62 [95% CI 1.16-2.26]; p = 0.0049) patients. No significant difference was found between the EOP and LOP groups with regard to the likelihood of achieving %BSA < 3 or %BSA < 1 among all patients. However, LOP patients were more likely than EOP patients to achieve %BSA < 3 or %BSA < 1 in subgroups treated with infliximab (AOR 1.45 [95% CI 1.09-1.93; p = 0.0103] and AOR 1.36 [95% CI 1.03-1.78; p = 0.0290], respectively) and etanercept (AOR 1.30 [95% CI 1.06-1.61; p = 0.0123] and AOR 1.34 [95% CI 1.09-1.64; p = 0.0053], respectively). CONCLUSION: Our real-world data from PSOLAR indicate that there are differences in some patient characteristics between EOP and LOP and that patients with EOP are less likely than those with LOP to respond to certain systemic treatments. (ClinicalTrials.gov identifier: NCT00508547).