Older adults are more likely to be poorly represented in randomized controlled trials of systemic treatment for plaque psoriasis, according to findings published in the Journal of the American Academy of Dermatology.
“In several medical fields it has been shown that RCTs often exclude or underrepresent older adults, possibly leading to clinical risks when treating this ineligible population. Both direct exclusion (age-limit based) [and] indirect exclusion (by other exclusion criteria disproportionally excluding older adults) might lead to an underrepresentation of older adults in RCTs,” Mirjam J. Schaap, MD, from the department of dermatology, Radboud University Medical Center, Nijmegen, The Netherlands, and colleagues wrote.
Researchers performed a systematic literature search of PubMed/MEDLINE, Embase and CENTRAL databases for randomized controlled trials involving systemic treatments in plaque psoriasis over a 15-year period. The two main factors assessed were direct exclusion based on age limits and indirect exclusion based on other exclusion criteria. Two independent reviewers completed data extraction.
One hundred sixty-two trials were fully reviewed, with 54 (33.3%) showing an upper age limit of 55 to 85 years. Two trials had no exclusion criteria, and 106 trials reported exclusion criteria but did not have an upper age limit. However, 96 of those trials (90.6%) had some form of exclusion criteria that might disproportionately affect older adults.
The most commonly mentioned exclusion criteria were serious concurrent infection, malignancy, hematologic disease, immunodeficiency, and hepatic or renal impairment.
“Given the increasingly aging world population, the need for guidance in treating older adults with psoriasis is likely to increase over time. In order to be able to make better and more thoughtful management choices in older adults in the future, more clinical research is needed regarding the efficacy and safety of systemic therapy in older psoriasis patients,” Schaap and colleagues wrote. – by Alexandria Brooks
Disclosures: Schaap reports carrying out clinical trials for Celgene, Janssen and Lilly. Please see the study for all other authors’ relevant financial disclosures.