Would oral roflumilast be a reasonable and tolerable option for severe psoriasis in an elderly patient with a history of pulmonary aspergillosis who has failed other systemic therapies?

It couldn't be a better option. Shouldn't exacerbate the aspergillosis at all, might help with the COPD, and is substantially more effective than apremilast (at least that's my take based on the data - no head-to-head data). I'd estimate that 30% of elderly patients can't tolerate it, but the other ...