Real-World Experience of Guselkumab in the Elderly Population

Introduction: Psoriasis is a chronic inflammatory disease whose burden peaks in older age groups. Despite the increasing prevalence of elderly patients with moderate-to-severe psoriasis, real-world data on biologics in this population remain limited, particularly for anti-IL-23 agents like guselkumab. This study evaluates the long-term effectiveness and safety of guselkumab in patients aged ≥65 years. Methods: This retrospective study included 66 patients aged ≥65 years with plaque psoriasis treated with guselkumab 100 mg between June 2019 and June 2024. PASI scores were recorded at baseline and during follow-up visits at weeks 4, 16, 24, 36, 52, 76, and 104. Effectiveness was assessed using PASI75/90/100 and PASI ≤ 2 responses. Multivariable logistic regression with Firth correction identified baseline predictors of PASI90 and PASI100 at weeks 16 and 52. Safety outcomes included treatment-emergent adverse events (TEAEs). Results: Mean PASI improved from 13.3 at baseline to 1.0 at week 24 and remained stable through week 104. PASI90 and PASI100 were achieved by 83.9% and 71.0% at week 36 and maintained in 69.2% and 61.5% at week 104. Higher baseline PASI independently predicted PASI90 and PASI100 at week 16, while lower eosinophil-to-lymphocyte ratio (ELR) independently predicted PASI100. At week 52, chronic beta-blocker intake and PASI90 at week 16 predicted PASI90 response, while PASI100 was independently associated with low-dose aspirin use and positive family history of psoriasis. TEAEs occurred in 16.7% of patients, with treatment discontinued in 9.1%. Eczematous or urticarial AEs were associated with elevated baseline eosinophils and ELR. Conclusion: Guselkumab is effective and well tolerated in older adults with psoriasis. Baseline ELR, early PASI response, and chronic use of beta-blockers or aspirin may influence long-term treatment outcomes. While limited by the small sample size (66 patients), our findings represent the longest real-world follow-up to date among older psoriatic patients treated with guselkumab and support its use as a valuable therapeutic option in this population.