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

Abstract

Background 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.Objectives 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.Methods 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.Results 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.Conclusions 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.