Treatment response to systemic therapies in pediatric-onset versus adult-onset psoriasis: a longitudinal real-world...

Psoriasis may present with onset in childhood or adulthood, reflecting distinct clinical patterns. Whether treatment response differs between these groups remains unclear, particularly across systemic therapies in real-world settings.

To compare longitudinal treatment responses between patients with pediatric-onset psoriasis (POPPs) and patients with adult-onset psoriasis (AOPPs) across systemic therapies in real-world practice.

Psoriasis patients receiving interleukin (IL)-17 inhibitors, IL-23 or IL-12/23 inhibitors, methotrexate, or phototherapy were included. Primary outcomes were Psoriasis Area and Severity Index (PASI) 90 and Dermatology Life Quality Index (DLQI) 0/1 at 1, 2, 3, and 6 months. Associations between onset group and treatment outcomes were assessed using generalized estimating equation (GEE) models with adjustment for potential confounders.

Among 1873 patients, 576 received IL-17 inhibitors, POPPs had higher PASI90 rates at 1-6 months (26.1%-62.2% vs. 14.6%-51.2%) and higher DLQI 0/1 response rates (30.6%-45.0% vs. 20.3%-40.0%) than AOPPs. Multivariable GEE analyses further demonstrated that, compared with POPPs, AOPPs had lower odds of achieving PASI90 (adjusted odds ratios 0.62, 95% confidence interval 0.42-0.89; p = .011). No significant differences were shown among patients treated with IL-23 or IL-12/23 inhibitors, methotrexate, or phototherapy.

Pediatric-onset psoriasis was associated with improved clinical outcomes during IL-17 inhibitor therapy. Further comparative-effectiveness studies are warranted to determine whether onset pattern may contribute to individualized treatment selection.