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

Background: Elderly patients (≥65 years) represent an increasing rate of psoriatic patients, 15% have moderate-to-severe disease. Biologics are being frequently used even if safety and efficacy data are limited. Objective: Evaluate and compare guselkumab, risankizumab, and tildrakizumab safety and efficacy in real-word-practice in elderly patients. Methods: A 40/44 weeks single-center retrospective study enrolled patients aged≥65 years suffering from moderate-to-severe plaque-psoriasis, treated with guselkumab, risankizumab, or tildrakizumab. Results: Thirty-four patients were enrolled (n=20 guselkumab; n=8 risankizumab; n=6 tildrakizumab). At week 4, 29.4% reached PASI90 and 8.8% PASI100; at week 28, PASI90 and PASI100 were observed in 58.8% and 29.4%, respectively. At week 40-44, data are available only for guselkumab and risankizumab groups in which 71.4% reached PASI90 and 53.5% PASI100. Four patients (11.7%) discontinued treatment. No significant differences were found among groups. Limitations: Retrospective nature of the study, small sample size, non-equal follow-up duration among the groups, lower number of tildrakizumab patients, and higher components of guselkumab (different commercialization date). Conclusion: Anti-IL-23s are promising, safe, and effective treatment options in elderlies without significant difference among them. However, more data are needed to confirm our results and to understand their role in the management of these more fragile patients.