Biologic therapy in geriatric psoriasis: 6-month real-world data on PASI, inflammatory indices, and hepatitis B/tuberculosis safety

Real-world evidence regarding biologic therapy in geriatric psoriasis is limited, particularly concerning systemic inflammatory burden and infection-related safety. This study evaluates the clinical efficacy of biologic therapy and its impact on systemic inflammatory indices while emphasizing safety related to hepatitis B virus (HBV) serology and tuberculosis screening. We conducted a retrospective analysis of eighty biologic-naïve patients aged 65 years and older with plaque psoriasis undergoing biologic therapy. Patients were categorized by biologic class: tumor necrosis factor-α (TNF-α) inhibitors, interleukin-17 inhibitors, an interleukin-12/23 inhibitor, and interleukin-23 inhibitors. The primary outcomes included changes in Psoriasis Area and Severity Index (PASI) scores and blood count-derived inflammatory indices over time (baseline and 6 months). Secondary outcomes encompassed changes in HBV serologic status and QuantiFERON-TB (QFT) results. Data analysis utilized longitudinal mixed-effects models for repeated measures. Blood count-derived inflammatory indices, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), were assessed at baseline and 6 months, alongside HBV serology and QFT results. PASI scores demonstrated significant improvement over time (p < 0.001), with no notable differences among biologic classes after adjusting for baseline covariates. Significant time effects were observed for all inflammatory indices (all p < 0.001), with significant group × time interactions noted for SII and NLR (both p < 0.05). Variability in HBV serologic markers and QFT results was observed during follow-up; however, no cases of active tuberculosis or clinically overt hepatitis were identified. In conclusion, biologic therapy led to substantial clinical improvement in geriatric psoriasis, accompanied by reductions in systemic inflammatory indices over a 6-month period, without evidence of clinically overt hepatitis or active tuberculosis during follow-up.