Treatment responses in pediatric- vs adult-onset psoriasis: A SPEECH registry study

Results from a Shanghai Psoriasis Effectiveness Evaluation CoHort (SPEECH) registry study, comparing longitudinal treatment responses between patients with pediatric-onset psoriasis (POPPs; onset <18 years; n = 260) and patients with adult-onset psoriasis (AOPPs; onset ≥18 years; n = 1,613) receiving systemic therapies in routine clinical practice, were published in the Journal of Dermatological Treatment by Li et al. Primary clinical outcomes assessed were ≥90% improvement from baseline in Psoriasis Area and Severity Index (PASI90) and Dermatology Life Quality Index (DLQI) score of 0/1 at 1, 2, 3, and 6 months. 

Key data: Among patients who received IL-17 inhibitors (n = 576), PASI90 response rates in POPPs vs AOPPs were 26.1% vs 14.6% at 1 month, 45.9% vs 35.1% at 2 months, 55.0% vs 50.3% at 3 months, and 62.2% vs 51.2% at 6 months; corresponding DLQI 0/1 response rates were 30.6% vs 20.3%, 39.6% vs 28.8%, 43.2% vs 36.8%, and 45.0% vs 40.0%. In multivariable analysis, AOPPs were less likely to attain PASI90 (adjusted odds ratio [AOR], 0.62; 95% confidence interval [CI], 0.42–0.89; p = 0.011) and DLQI 0/1 (AOR, 0.58; 95% CI, 0.38–0.87; p = 0.008) than POPPs. No significant differences in PASI90 or DLQI 0/1 response rates were observed between POPPs vs AOPPs receiving IL-23 or IL-12/23 inhibitors (n = 272; PASI90, p = 0.214; DLQI 0/1, p = 0.337), methotrexate (n = 570; PASI90, p = 0.972; DLQI 0/1, p = 0.756), or phototherapy (n = 455; PASI90, p = 0.849; DLQI 0/1, p = 0.383). 

Key learning: In this study, POPPs achieved better PASI90 and DLQI 0/1 outcomes vs AOPPs during IL-17 inhibitor therapy in a real-world setting. These findings support further evaluation of onset pattern as a potential marker of treatment response.