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

Abstract

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).

Conflict of interest statement

S. Singh has no conflicts of interest. R. E. Kalb has received grants and/or research funding from AbbVie, Amgen, Janssen, Merck & Co, Inc., and Novartis Pharmaceuticals Corp.; served as a consultant for Dermira, Janssen-Ortho, Inc., Regeneron, and Sun Pharmaceutical Industries, Ltd.; and was a member of a Data Safety Monitoring Board for Eli Lilly and Company. E.M.G.J. de Jong has received research grants for the independent research fund of the Dept. of Dermatology of the Radboud University Medical Center from AbbVie, Janssen, and Pfizer; and has acted as consultant and/or paid speaker for and/or participated in research sponsored by companies manufacturing drugs for the treatment of psoriasis, including AbbVie, Amgen, Celgene, Eli Lilly, Janssen, MSD, Novartis, and Pfizer (all funding goes to the independent research fund of “Radboud”). N. H. Shear has been a paid consultant for AbbVie, Actelion, Biogen, Celgene, Janssen, Leo, Lilly, Novartis, and Sanofi. M. Lebwohl is an employee of Mount Sinai, which receives research funds from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen/Johnson & Johnson, Kadmon, Medimmune/Astra Zeneca, Novartis, Pfizer, and ViDac. B. Srivastava and L. Hopkins are employees of Janssen Scientific Affairs, LLC, and W. Langholff is an employee of Janssen Research & Development, LLC. A.W. Armstrong has served as investigator, advisor, and/or consultant to AbbVie, Janssen, Novartis, Lilly, Regeneron, Sanofi, Leo, and Ortho Dermatologics.