Effectiveness and Safety of Tildrakizumab in Elderly and Frail Elderly Psoriatic Patients Up to 2 years.

Purpose: Elderly patients with age ≥65 years represent an increasing percentage of the population with moderate-severe psoriasis. The definition of "frail elderly" is not easily framed, generally meaning a patient with unstable homeostasis. To date, there is no study in the literature examining possible differences between frail and non-frail elderly with psoriasis being treated with tildrakizumab. Patients and Methods: The present multicentre retrospective study evaluated the effectiveness, drug survival and safety up to 2 years of treatment with tildrakizumab in the elderly (≥65 years) comparing frail and non-frail patients. Frail patients were defined as those with: i) 2 major comorbidities, or 1 major comorbidity and low economic level ii) and/or 2 of the following 5 parameters: weight loss, weakness, sluggishness, low activity level, and exhaustion. Results: A total of 217 patients aged ≥65 years were enrolled, of whom 89 (41%) were grouped in the frail patient category. In the entire population, 2-year drug survival was ≥80%, and PASI 90 and ≤2 was achieved in 75% and 87.5% of patients, respectively. No difference in effectiveness or safety was found between frail and non-frail populations. Adjusting for baseline characteristics at Cox-regression, frail patients did not show a greater risk of discontinuation (HR 0.51, p=0.091). Conclusion: Tildrakizumab showed good safety and effectiveness at 2 years in the elderly population with or without frailty, confirming it as a possible treatment of choice in psoriatic patients with significant comorbidities and older frail patients who deserve systemic treatments.