Advancing Age May Affect Psoriasis Patients' Access to Biologics

Elderly psoriasis patients may be less likely to receive biologics, according to a new study out of Umeå University in Sweden.

Specifically, an age increase of 30 years resulted in an average 65 percent reduction in likelihood of obtaining treatment with biologics in this population, the study showed.

Researchers analyzed health data from 1,465 patients with psoriasis using a model which measured what effect aging had on the probability of starting treatment with biologics. The study took into account variables such as gender, BMI, comorbidity, assessed severity of psoriasis, and the educational level of the patient. These variables are known to affect prescription of biologics.

The findings appear in the British Journal of Dermatology.

"There are huge differences in access of treatments with biologics between patients who seem the same in all other aspects apart from age," says Marcus Schmitt-Egenolf, MD PhD, professor of dermatology at the Department of Public Health and Clinical Medicine at Umeå University and senior author of the article, in a news release.

"The differences are becoming increasingly clear if you compare a mother to her daughter and supposes that there is a 30-year age difference. The chances for the mother to start a treatment with biologics are then a third in comparison to the daughter and the only reason for this is her age."

When DermWire asked Dr. Schmitt-Egenolf what he believes is responsible for the findings, he cited coping and patient preference. "But we can not exclude a component of discrimination either,” he added.

U.S. Psoriasis Expert Reacts to Findings

When asked whether the new study findings apply outside of Sweden, Bruce E. Strober, M.D., Ph.D.,  an associate professor of dermatology and Chair of the Department of Dermatology at UConn Health Farmington, Conn. says that “different health care systems may bring increased or decreased access to people depending on age."

For example, “prescription drug coverage may vary, too, based on age. In the United States, for example, many prescription biologic agents approved for psoriasis are not adequately covered by Medicare, therefore this dramatically reduces access to these drugs for elderly patients,” he says.

“There may be a prevalent perception among practitioners that immunosuppression, a feature of most good psoriasis medications, is a higher risk therapeutic choice for elderly patients. This would be a sentiment supported by data that show some elderly patients are at a greater risk for serious infection when they are treated with immunosuppressive drugs. So practitioners who shy away from using these drugs in older populations might, in some cases, be practicing prudently, or, in the very least, with greater caution,” he says.

“If this phenomenon were to be shown in the United States I therefore would not be surprised.”