Safety and efficacy of interleukin inhibitors in elderly patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis

Elderly patients with rheumatoid arthritis, psoriasis and psoriatic arthritis encompass those with elderly-onset disease, over 60 years of age, but also those with earlier disease onset who entered old age. Considering the age-related changes of the immune system, possible frailty, susceptibility to infection and concomitant comorbidity that implies multiple medicines, the treatment of these diseases in elderly patients can be challenging. Interleukin inhibitors have been shown to be an efficient and safe treatment for these diseases. However, elderly patients with these diseases were often included in the pivotal clinical trials for interleukin inhibitors in numbers insufficient to determine whether they responded differently from younger subjects. The aim of this paper was to review the findings on the efficacy and safety of interleukin inhibitor treatment in elderly patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis.The findings suggest that, for all the interleukin inhibitors reviewed herein, used in elderly patients with rheumatoid arthritis, or with psoriasis and psoriatic arthritis, the efficacy was comparable to younger patients. Furthermore, the incidence of reported adverse events was similar in these two age groups. Severe adverse events, which were related to sarilumab treatment for rheumatoid arthritis and secukinumab treatment for psoriasis, were higher in elderly patients.The reviewed findings suggest that the interleukin inhibitors approved and currently in use in clinical practice for the treatment of rheumatoid arthritis, psoriasis, and psoriatic arthritis can be considered a safe and efficient option for these diseases in elderly patients.
Stariji pacijenti koji boluju od reumatoidnog artritisa, psorijaze ili psorijaznog artritisa uključuju one kod kojih je bolest imala kasni početak, nakon 60. godine starosti, ali takođe i one pacijente kod kojih je bolest počela ranije, a koji su ušli u staro doba. Imajući u vidu starenjem uslovljene promene imunskog sistema, moguću slabost starijih, podložnost infekcijama, prateći komorbiditet, koji uključuje i uzimanje više lekova, terapija ovih bolesti kod starijih pacijenata može predstavljati izazov. Inhibitori interleukina su se pokazali kao efikasna i bezbedna terapija ovih poremećaja. Međutim, stariji pacijenti sa ovim bolestima su često bili nedovoljno zastupljeni u ključnim kliničkim ispitivanjima inhibitora interleukina da bi se moglo sa sigurnošću utvrditi da postoji razlika u terapijskom odgovoru kod ovih pacijenata u odnosu na isti kod mlađih pacijenata. Cilj ovog rada bio je da prikaže nalaze od značaja za bezbednost i efikasnost terapije inhibitorima interleukina kod starijih pacijenata sa reumatoidnim artritisom, psorijazom ili psorijaznim artritisom. Nalazi ukazuju da je efikasnost inhibitora interleukina, prikazanih u ovom radu, uporediva kod starijih i mlađih pacijenata. Osim toga, incidencija neželjenih događaja se nije razlikovala između ove dve starosne grupe. Veća incidencija teških neželjenih događaja kod starijih pacijenata u odnosu na mlađe bila je zabeležena u terapiji reumatoidnog artritisa sarilumabom i psorijaze secukinumabom. Terapija reumatoidnog artritisa, psorijaze i psorijaznog artritisa inhibitorima interleukina može se smatrati efikasnom i bezbednom u populaciji starih pacijenata.