Journal of the American Academy of Dermatology | 2019
Representation of older adults in randomized controlled trials on systemic treatment in plaque psoriasis: A systematic review.
Abstract
BACKGROUND\nPsoriasis is frequently seen in older patients and systemic treatment is often indicated. Randomized controlled trials (RCTs) generally maintain strict in- and exclusion criteria, which might lead to a disproportionally high exclusion rate of older adults.\n\n\nOBJECTIVE\nTo determine the representation of older adults (≥65 years) in RCTs studying systemic treatment in plaque psoriasis.\n\n\nMETHODS\nA systematic literature search was performed in PubMed/MEDLINE, EMBASE and CENTRAL, including RCTs concerning systemic treatments in plaque psoriasis in the past 15 years. Direct exclusion (age-limit based) and indirect exclusion (other exclusion criteria) were assessed. Study selection and data extraction was done by two independent reviewers.\n\n\nRESULTS\nOf 162 trials reviewed in full, 54 (33.3%) maintained an upper age limit (55-85 years). Of the remaining 108 trials, 106 reported exclusion criteria and did not handle an upper age limit. However, 96 (90.6%) of these trials used exclusion criteria that might unequally affect older adults. The exclusion criteria serious concurrent infection (n=104; 66.7%) and malignancy (n=100; 64.1%) were most commonly mentioned in the included RCTs.\n\n\nLIMITATIONS\nOnly published RCTs were included.\n\n\nCONCLUSION\nOlder adults might be poorly represented in RCTs studying systemic treatment in plaque psoriasis, due to a high rate of (in)direct exclusion.