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Sánchez-Díaz M, Flórez Á, Carretero-Hernández G, Grau-Pérez M, García-Doval I, Carrascosa-Carrillo JM. Study of the Impact of Restrictions on Access to Biological Drugs for the Management of Psoriasis on the Minimum Disease Activity Criteria: Subanalysis of AEDV EQUIDAD and AME Projects. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00415-0. [PMID: 38768808 DOI: 10.1016/j.ad.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/05/2023] [Accepted: 02/06/2024] [Indexed: 05/22/2024] Open
Abstract
Spanish Autonomous Communities (ACs) are entitled to decide on the prescription requirements of their own territories, which can create inequalities in access to new drugs in the management of psoriasis. The objective of this study was to assess whether the level of restrictions in the access to new drugs for the management psoriasis was associated with the probability of achieving disease control measured using the Minimum Disease Activity (MDA) criteria. Therefore, we combined the results of 2 previous independent, cross-sectional studies: one that described the MDA in psoriasis by AC, and another that evaluated the level of restrictions to drug access by AC. We found that the higher the number of restrictions the lower the chances of achieving the MDA criteria (P=.013). Our results suggest that, in Spain, geographical differences in the access to new drugs may be creating health inequalities across the country.
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Affiliation(s)
- M Sánchez-Díaz
- Unidad de Investigación, Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Hospital Universitario Virgen de las Nieves Instituto de Investigación Biosanitaria IBS, Granada, España
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, España
| | - G Carretero-Hernández
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Isla de Gran Canaria, España
| | - M Grau-Pérez
- Servicio de Dermatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España; Unidad de Investigación, Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, España
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Hospital do Meixoeiro, Vigo, Pontevedra, España.
| | - J M Carrascosa-Carrillo
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
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2
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Liang H, Kirk B, Polinski JM, Yue X, Kilpatrick RD, Gelfand JM. Impact of Season and Other Factors on Initiation, Discontinuation, and Switching of Systemic Drug Therapy in Patients with Psoriasis: A Retrospective Study. JID INNOVATIONS 2023; 3:100171. [PMID: 36876219 PMCID: PMC9982330 DOI: 10.1016/j.xjidi.2022.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/12/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
This study investigated whether systemic drug prescribing for psoriasis varies by season and other exacerbating factors. Eligible patients with psoriasis were assessed for each season for initiation, discontinuation, and switching of systemic drugs. A total of 360,787 patients were at risk of initiating any systemic drugs in 2016‒2019; 39,572 patients and 35,388 patients were at risk of drug discontinuation or switching to a biologic and a nonbiologic systemic drug, respectively. The initiation of biologic therapy in 2016‒2019 peaked in spring (1.28%), followed by summer (1.11%), fall (1.08%), and winter (1.01%). Nonbiologic systemic drugs followed a similar pattern. Those aged 30‒39 years, male, those with psoriatic arthritis, those who live in the South region, those who live in areas with lower altitudes, and those who live in areas with lower humidity had higher initiation with the same seasonality pattern. Discontinuation of biologic drugs peaked in summer, and switching of biologics was highest in spring. Season is associated with initiation, discontinuation, and switching, although seasonality pattern is less clear for nonbiologic systemic drugs. Approximately 14,280 more patients with psoriasis in the United States are estimated to initiate a biologic in spring than in other seasons, and over 840 more biologic users switched in spring than in winter. The findings may provide evidence for healthcare resource planning in psoriasis management.
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Affiliation(s)
- Huifang Liang
- Global Epidemiology, Pharmacovigilance and Patient Safety, AbbVie, North Chicago, Illinois, USA
| | | | | | - Xiaomeng Yue
- Global Epidemiology, Pharmacovigilance and Patient Safety, AbbVie, North Chicago, Illinois, USA
| | - Ryan D Kilpatrick
- Global Epidemiology, Pharmacovigilance and Patient Safety, AbbVie, North Chicago, Illinois, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Megna M, Potestio L, Fabbrocini G, Camela E. Treating psoriasis in the elderly: biologics and small molecules. Expert Opin Biol Ther 2022; 22:1503-1520. [PMID: 35695241 DOI: 10.1080/14712598.2022.2089020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Psoriasis prevalence in the elderly is growing. It is estimated that 15% of elderly psoriasis patients suffer from moderate-to-severe disease, thus requiring systemic treatments. However, conventional systemic agents' use is limited due to contraindications and drug-interactions. Conversely, biologics and small molecules seem to be a valuable option, although the geriatric psoriasis population is frequently excluded from trials and shared guidelines are lacking. AREAS COVERED Relevant English literature (trials, real-life studies, case series, and reviews) regarding biologics and/or small molecules in the elderly were searched for up to January 17, 2022. EXPERT OPINION Treatment of moderate-to-severe psoriasis in the elderly may be challenging due to multiple comorbidities, polypharmacy, and increased risk of infections and cancers. However, new targeted therapies offer the possibility to perform a tailored-tail management, considering comorbidities, drug-interactions, and frailties which characterize this class of patients. Several real-world data support biologics and small molecules' efficacy and safety in the elderly with mainly no significant difference as compared to young adults. Elderly psoriasis patients' expectations are as high as those of their younger counterparts. Hence, they deserve the best therapeutic options according to their peculiarities for a long-term psoriasis remission and an improved quality of life.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elisa Camela
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Drug Survival, Safety, and Effectiveness of Biologics in Older Patients with Psoriasis: A Comparison with Younger Patients-A BioCAPTURE Registry Study. Drugs Aging 2022; 39:715-727. [PMID: 35859228 PMCID: PMC9300332 DOI: 10.1007/s40266-022-00961-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Psoriasis is a common inflammatory disease in any age group, but also in older patients (≥ 65 years of age). Since older patients are often excluded from clinical trials, limited data specifically on this growing population are available, e.g. regarding the safety and performance of biological treatment. AIMS We aimed to give insight into this specific population by comparing the drug survival and safety of biologics in older patients with that in younger patients. METHODS In this real-world observational study, data from 3 academic and 15 non-academic centers in The Netherlands were extracted from the prospective BioCAPTURE registry. Biologics included in this study were tumor necrosis factor (TNF)-α, interleukin (IL)-17, IL-12/23, and IL-23 inhibitors. Patients were divided into two age groups: ≥ 65 years and < 65 years. The Charlson Comorbidity Index (CCI) was used to measure comorbid disease status, and all adverse events (AEs) that led to treatment discontinuation were classified according to the Medical Dictionary for Regulatory Activities (MedDRA) classification. All AEs that led to treatment discontinuation were studied to check whether they could be classified as serious AEs (SAEs). Kaplan-Meier survival curves for overall 5-year drug survival and split according to reasons of discontinuation (ineffectiveness or AEs) were constructed. Cox regression models were used to correct for possible confounders and to investigate associations with drug survival in both age groups separately. Psoriasis Area and Severity Index (PASI) scores during the first 2 years of treatment and at the time of treatment discontinuation were assessed and compared between age groups. RESULTS A total of 890 patients were included, of whom 102 (11.4%) were aged ≥ 65 years. Body mass index, sex, and distribution of biologic classes (e.g. TNFα, IL12/23) were not significantly different between the two age groups. A significantly higher CCI score was found in older patients, indicative of more comorbidity (p < 0.001). The 5-year ineffectiveness-related drug survival was lower for older patients (44.5% vs. 60.5%; p = 0.006), and the 5-year overall (≥ 65 years: 32.4% vs. < 65 years: 42.1%; p = 0.144) and AE-related (≥ 65 years: 82.1% vs. < 65 years: 79.5%; p = 0.913) drug survival was comparable between age groups. Of all AEs (n = 155) that led to discontinuation, 16 (10.3%) were reported as SAEs but these only occurred in younger patients. After correcting for confounders, the same trends were observed in the drug survival outcomes. Linear regression analyses on PASI scores showed no statistical differences at 6, 12, 18, and 24 months of treatment between age groups. CONCLUSIONS This study in a substantial, well-defined, prospective cohort provides further support that the use of biologics in older patients seems well-tolerated and effective. Biologic discontinuation due to AEs did not occur more frequently in older patients. Older patients discontinued biologic treatment more often due to ineffectiveness, although no clear difference in PASI scores was observed. More real-world studies on physician- and patient-related factors in older patients are warranted.
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Ter Haar ELM, Tummers M, Bronkhorst EM, van de Kerkhof PCM, de Jong EMGJ, Lubeek SFK. Age-based treatment differences in and reluctance to treating older adults with systemic antipsoriatic therapy - a mixed-method pilot study. J DERMATOL TREAT 2022; 33:2983-2990. [PMID: 35762362 DOI: 10.1080/09546634.2022.2089330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Evidence-based guidance in older adults (≥65 years) with psoriasis is sparse and undertreatment might be present. OBJECTIVES To assess prescribing patterns, comfort levels, barriers and needs of dermatologists when treating older adults with systemic antipsoriatic therapy. METHODS A mixed-methods design was used including a survey among all Dutch dermatologists and residents, followed by semi-structured interviews. RESULTS Most of the survey respondents applied systemic treatment to the same extent in older versus younger patients (n = 49; 67.1%) and weren't reluctant prescribing systemic therapy (n = 50; 68.5%) in older adults. However, 26% (n = 19) of the respondents treated older adults less often with systemic therapy compared to younger patients and 68.1% (n = 49) performed additional actions in older adults, e.g. intensified monitoring or dose reduction. Based on the survey and interviews (n = 10), the main reasons for these age-based treatment differences were comorbidity, comedication, and fear of adverse events. More evidence-based guidance, education, and time to assess older adults were identified as most important needs, especially regarding frailty screening. CONCLUSIONS Age-based treatment differences in and reluctance to treating older adults with systemic antipsoriatic therapy were common. There is a need for more evidence-based guidance, education, and consultation time, to improve treatment in this growing population.
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Affiliation(s)
- Elke L M Ter Haar
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Satish F K Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Husni ME, Chang E, Broder MS, Paydar C, Bognar K, Desai P, Klyachkin Y, Khilfeh I. Biologic Initiation Rate in Systemic-Naïve Psoriatic Arthritis Patients Starting Treatment with Apremilast vs Methotrexate: 1-Year Retrospective Analysis of a US Claims Database. Open Access Rheumatol 2022; 14:123-132. [PMID: 35734243 PMCID: PMC9207121 DOI: 10.2147/oarrr.s342123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the rate of biologic initiation after commencing treatment with apremilast (APR) vs methotrexate (MTX), in systemic-naïve patients with psoriatic arthritis (PsA). Patients and Methods Systemic-naïve patients with PsA who started treatment with either APR or MTX between 01/01/2015 and 12/31/2018 were analyzed using claims data from the IBM® MarketScan® Commercial and Medicare Supplemental databases (2014-2019). PsA patients were identified via diagnosis codes; the first prescription date for APR or MTX was the index date. Patient demographics, clinical characteristics, healthcare utilization during the year pre-index (baseline) and the year post-index (follow-up), and median time to biologic initiation were reported descriptively. The rates and risk of biologic initiation during follow-up were compared between APR and MTX users by logistic and Cox regressions, respectively. Models were adjusted for demographics, clinical and utilization measures during the baseline period. Results A total of 2116 patients with PsA newly treated with APR (n = 534) or MTX (n = 1582) were identified. Mean age was similar (50.5 vs 50.4; P = 0.938), and proportion of females was higher for APR vs MTX users (59.4% vs 54.0%; P = 0.031). Mean time to biologic initiation among patients who initiated during follow-up was 194.1 vs 138.7 days between APR vs MTX users (P < 0.001). After adjusting for confounders, the likelihood of biologic initiation was 58% lower (OR, 0.42 [95% CI, 0.32-0.54]; P < 0.001) with APR, with a significantly lower predicted rate of biologic initiation among APR users when compared to MTX users during follow-up (20.0% [95% CI, 16.6-23.9%] vs 37.5% [95% CI, 35.0-40.1%]). Additionally, APR users had a lower risk of biologic initiation than MTX users (HR, 0.46 [95% CI, 0.37-0.57]; P < 0.001) during the 1-year follow-up. Conclusion Systemic-naïve patients with PsA have a lower rate of, and longer time to, biologic initiation over one-year following APR initiation, compared to those initiating MTX.
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Affiliation(s)
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Caleb Paydar
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Katalin Bognar
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
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Asili P, Tootoonchi N, Nasimi M, Daneshpajooh M, Sedaghatzadeh M, Mirahmad M. Demographic aspects, clinical characteristics, and therapeutic approaches in geriatric psoriasis: A study from a tertiary center. Dermatol Ther 2022; 35:e15628. [PMID: 35678465 DOI: 10.1111/dth.15628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/02/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Geriatric psoriasis, due to its unusual clinical manifestations and higher rates of systemic complications in this age group, is a challenging issue for dermatologists. Therefore, we aimed to provide an overview of the epidemiological, clinical and therapeutic consequences among patients aged over 60 years with psoriasis in a referral center in Iran. MATERIALS AND METHODS This cross-sectional study was conducted on 156 patients over 60 years with the definitive diagnosis of psoriasis that were referred to our center between 2015 and 2019. By reviewing the recorded files of the patients, baseline characteristics including demographics, underlying comorbidities, age of disease onset, clinical type of the disease, clinical manifestations, and therapeutic approaches were extracted. RESULTS The most common clinical feature was plaque type (73.1%) followed by pustular type (10.9%). The most frequent involved zone was the lower extremities (84.6%). Most of the patients were treated topically (87.1%), while as the most frequent systemic approaches, methotrexate and acitretin were considered for 74.4% and 60.3%, respectively. A significantly higher mean age at disease onset was found in female patients compared to male patients. The plaque type was more prevalent in men than in women. Also, the chance of nail involvement was 2.43 times higher in men than in women (p=0.011, 95%CI: 1.22-4.84). The disease duration was significantly longer in patients suffering from plaque compared to those without this feature. Conversely, those with palmoplantar type experienced shorter disease duration. Psoriatic arthritis was also revealed in patients of lower ages. CONCLUSION As in other societies, in our society, clinical characteristics, disease involvement patterns, as well as considered treatment approaches, can be influenced by demographic characteristics. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pooria Asili
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Tootoonchi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasimi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpajooh
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Mirahmad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Kaplan D, Husni E, Chang E, S Broder M, Paydar C, Bognar K, Yan J, Richter S, Desai P, Khilfeh I. Biologic initiation rates in systemic-naive psoriasis patients after first-line apremilast versus methotrexate use. J Comp Eff Res 2022; 11:575-582. [PMID: 35514324 DOI: 10.2217/cer-2021-0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare rates of biologic initiation after commencing treatment with apremilast (APR) versus methotrexate (MTX) in systemic-naive patients with psoriasis (PsO). Methods: This was a retrospective cohort study of systemic-naive patients with PsO who initiated treatment with APR or MTX between 1 January 2015 and 31 March 2018. Outcomes: Adjusted rates of biologic initiation during follow-up were compared by logistic and Cox regressions. Results: APR initiators had 58% lower likelihood of biologic initiation (odds ratio: 0.42; 95% CI: 0.37-0.48; p < 0.001), lower adjusted biologic initiation rate (14.4% [95% CI: 13.2-15.7%] vs 28.6% [95% CI: 26.8-30.5%]), lower risk of biologic initiation (hazard ratio: 0.45; 95% CI: 0.40-0.51; p < 0.001) compared with MTX initiators. Conclusion: Systemic-naive patients with PsO have a lower rate of biologic initiation over 1 year following APR initiation.
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Affiliation(s)
- David Kaplan
- Adult & Pediatric Dermatology, Overland Park, KS 66211, USA
| | - Elaine Husni
- Cleveland Clinic Department of Rheumatic and Immunologic Diseases, Cleveland, OH 44195, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, USA
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, USA
| | - Caleb Paydar
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, USA
| | - Kata Bognar
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, USA
| | - Jessie Yan
- Roche, South San Francisco, CA 94080, USA
| | | | - Pooja Desai
- Janssen Pharmaceuticals, Titusville, NJ 08560, USA
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9
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Chat VS, Hekmatjah J, Sierro TJ, Kassardjian AA, Read C, Armstrong AW. Language proficiency and biologics access: a population study of psoriasis patients in the United States. J DERMATOL TREAT 2022; 33:1413-1417. [DOI: 10.1080/09546634.2020.1820936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Vipawee S. Chat
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Joshua Hekmatjah
- Homer Stryker M.D. Schoolof Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - Tiffany J. Sierro
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| | - Ari A. Kassardjian
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| | - Charlotte Read
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
- Department of Medicine, Imperial College London, London, UK
| | - April W. Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
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Milan R, LeLorier J, Brouillette MJ, Holbrook A, Litvinov IV, Rahme E. Sex Differences in the Patterns of Systemic Agent use Among Patients With Psoriasis: A Retrospective Cohort Study in Quebec, Canada. Front Pharmacol 2022; 13:810309. [PMID: 35242034 PMCID: PMC8886891 DOI: 10.3389/fphar.2022.810309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Sex differences exist in psoriasis manifestation and expectations from treatment with systemic agents, including, conventional systemic agents (CSA) and tumor necrosis factor inhibitors or ustekinumab (TNFi/UST). However, sex differences in patterns of systemic agent use, such as CSA discontinuation and switch from CSA to TNFi/UST have not been examined. Objectives: To assess sex differences in patterns of CSA use and identify factors associated with switch to (or add) a TNFi/UST and those associated with CSA discontinuation. Methods: We conducted a retrospective cohort study using the Quebec health administrative databases. We included patients with psoriasis initiating a CSA in 2002–2015. We excluded patients with a psoriasis diagnosis in the 3 years prior to the first diagnosis date between 2002 and 2015, and those with a systemic agent dispensation in the year prior to that date. We used Cox regression models with the Least Absolute Shrinkage and Selection Operator method to identify factors associated with Switch/add TNFi/UST, and those associated with CSA discontinuation. Separate analyses were performed for male and female patients. Results: We included 1,644 patients (55.7% females, mean age 60.3 years), among whom 60.4% discontinued their CSA and 7.4%, switched/added TNFi/UST (3.4% switched and 4.0% added) within a median of 0.78 years of follow-up. Among male and female patients, rates of Switch/add TNFi/UST per 1,000 person-year were 49.1 and 41.0 and rates of CSA discontinuation were 381.2 and 352.8. Clinical obesity in male patients (HR 3.53, 95% CI 1.20–10.35), and adjustment/somatoform/dissociative disorders (HR 3.17, 95% CI 1.28–7.85) and use of nonsteroidal anti-inflammatory drugs (HR 2.70, 95% CI 1.56–4.70) in female patients were associated with Switch/add TNFi/UST. Male patients followed by a rheumatologist (HR 0.66, 95% CI 0.46–0.94) and those with a prior hospitalization (HR 0.70, 95% CI 0.57–0.87) were at lower risk of CSA discontinuation, while those initiated on acitretin (vs methotrexate) were at higher risk to discontinue their CSA (HR 1.61, 95% CI 1.30–2.01). Female patients with rheumatoid arthritis comorbidity (HR 0.69, 95% CI 0.51–0.93), those with a dispensed lipid-lowering agent (HR 0.72, 95% CI 0.59–0.88) and hypoglycemic agent (HR 0.75, 95% CI 0.57–0.98) and those initiated on methotrexate (vs all other CSAs) were less likely to discontinue their CSA. Male and female patients entering the cohort between 2011 and 2015 were at reduced risk of CSA discontinuation compared to those entering the cohort before 2011. Conclusion: Most male and female patients discontinued their CSA within 1 year of follow-up. Our study highlighted sex differences in patients’ characteristics associated with switch/add a TNFi/UST and CSA discontinuation; treatment switch and discontinuation may be indications of treatment failure in most patients.
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Affiliation(s)
- Raymond Milan
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Jacques LeLorier
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche Du Centre Hospitalier De L'Université de Montréal, Montreal, QC, Canada
| | - Marie-Josée Brouillette
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Anne Holbrook
- Department of Medicine, Division of Clinical Pharmacology and Toxicology, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Ivan V Litvinov
- Department of Medicine, Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Elham Rahme
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
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11
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van Winden MEC, Ter Haar ELM, Groenewoud JMM, van de Kerkhof PCM, de Jong EMGJ, Lubeek SFK. Quality of life, treatment goals, preferences and satisfaction in older adults with psoriasis: a patient survey comparing age groups. Br J Dermatol 2020; 184:759-762. [PMID: 33152111 PMCID: PMC8246713 DOI: 10.1111/bjd.19665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022]
Affiliation(s)
- M E C van Winden
- Department of Dermatology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - E L M Ter Haar
- Department of Dermatology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - J M M Groenewoud
- Department for Health Evidence, Radboud University, Nijmegen, the Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - S F K Lubeek
- Department of Dermatology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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van Winden MEC, van der Schoot LS, van de L’Isle Arias M, van Vugt LJ, van den Reek JMPA, van de Kerkhof PCM, de Jong EMGJ, Lubeek SFK. Effectiveness and Safety of Systemic Therapy for Psoriasis in Older Adults. JAMA Dermatol 2020; 156:1229-1239. [DOI: 10.1001/jamadermatol.2020.2311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | - Lieke J. van Vugt
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Elke M. G. J. de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Satish F. K. Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
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13
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Baumgart DC, Misery L, Naeyaert S, Taylor PC. Biological Therapies in Immune-Mediated Inflammatory Diseases: Can Biosimilars Reduce Access Inequities? Front Pharmacol 2019; 10:279. [PMID: 30983996 PMCID: PMC6447826 DOI: 10.3389/fphar.2019.00279] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/05/2019] [Indexed: 12/30/2022] Open
Abstract
Biological therapies are an effective treatment for a range of immune-mediated inflammatory diseases (IMIDs), including rheumatoid arthritis, psoriasis, and inflammatory bowel diseases. However, due to their high costs, considerable differences in their utilization exist across the world, even among the various European countries, with many countries restricting access despite professional society guideline recommendations. Adoption of biologics by healthcare providers has been particularly poor in many Central and Eastern European countries. Differences in utilization have also been observed across medical specialties, healthcare providers, and at a regional and national level. The objective of this paper is to provide an overview of the different market access policies for biologics in Europe and to investigate reasons for such differences. One of the potential solutions for providing broader access to IMID patients, where cost is the major barrier, is to encourage the use of biosimilars in place of their reference products. Biosimilars are generally less expensive alternatives to already licensed biological therapies and are approved on the basis that they are similar to the reference product in terms of quality, safety, and efficacy. Budget impact models predict considerable cost savings following the introduction of biosimilars in the next few years. These savings could be used to increase access to biologics and other innovative therapies.
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Affiliation(s)
- Daniel C. Baumgart
- Inflammatory Bowel Disease Unit – Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
- Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | | | - Peter C. Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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Löfvendahl S, Jöud A, Petersson IF, Theander E, Svensson Å, Carlsson KS. Income disparities in healthcare use remain after controlling for healthcare need: evidence from Swedish register data on psoriasis and psoriatic arthritis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:447-462. [PMID: 28527093 PMCID: PMC5978916 DOI: 10.1007/s10198-017-0895-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/04/2017] [Indexed: 05/31/2023]
Abstract
We used a southern Swedish cohort of psoriasis (PSO) and psoriatic arthritis (PsA) patients and population-based referents (N = 57,800) to investigate the influence of socioeconomic and demographic factors on the probability of healthcare use and on healthcare costs when controlling for need as measured by PSO/PsA and common additional morbidities such as diabetes, depression and myocardial infarction. People with PSO/PsA were identified by ICD-10 codes in the Skåne Healthcare Register 1998-2007. Resource use and costs for years 2008-2011 were retrieved from the Skåne Healthcare Register and the Swedish Prescribed Drug Register, and socioeconomic data were retrieved from Statistics Sweden. After controlling for PSO/PsA and common additional morbidities, income, and to some extent education, had significant effects on the probability of five types of healthcare use. Overall, income showed a bell-shaped relationship to healthcare costs, with patients in income quintiles 2 and 3 having the highest mean annualized cost irrespective of model specification. Education did not have a significant effect in most specifications. Analyses including interaction effects indicated similarly higher costs across income quintiles in the PSO and PsA subgroups, though these cost differences were lower in magnitude for patients with PSO in quintile 5 and with PsA in quintile 1. In conclusion, our results show persistent socioeconomic disparities in healthcare use among a cohort of chronically ill patients and referents, even after controlling for the presence of PSO/PsA and common additional morbidities. These disparities persist even in a country with general healthcare coverage and low out-of-pocket payments.
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Affiliation(s)
- Sofia Löfvendahl
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden.
- Health Technology Assessment Skåne, Skåne University Hospital, Lund, Sweden.
- Health Technology Assessment Skåne, Skåne University Hospital, Remissgatan 4, Wigerthuset, 221 85, Lund, Sweden.
| | - Anna Jöud
- Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Ingemar F Petersson
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
- Health Technology Assessment Skåne, Skåne University Hospital, Lund, Sweden
| | - Elke Theander
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Åke Svensson
- Department of Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Katarina Steen Carlsson
- Health Technology Assessment Skåne, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
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Kostović K, Žužul K, Čeović R, Bukvić Mokos Z. Psoriasis in the mature patient: Therapeutic approach in the era of biologics. Clin Dermatol 2018; 36:222-230. [DOI: 10.1016/j.clindermatol.2017.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ikeda K. Drug-Induced Oral Complications. Atlas Oral Maxillofac Surg Clin North Am 2017; 25:127-132. [PMID: 28778302 DOI: 10.1016/j.cxom.2017.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kentaro Ikeda
- Department of Diagnostics and Biological Sciences, University of Colorado School of Dental Medicine, 13065 East 17th Avenue, Mail Stop F844, Aurora, CO 80045, USA; Department of Family Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA.
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Affiliation(s)
- L. Puig
- Department of Dermatology; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Sant Quintí 89 08041 Barcelona Catalonia Spain
| | - P. Putrik
- Internal Medicine/Rheumatology; Maastricht University Medical Centre; CAPHRI; Maastricht the Netherlands
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18
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Naldi L, Cazzaniga S, Di Mercurio M, Grossi E, Addis A. Inequalities in access to biological treatments for psoriasis: results from the Italian Psocare registry. Br J Dermatol 2017; 176:1331-1338. [PMID: 27973689 DOI: 10.1111/bjd.15234] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Limited evidence is available on the impact of socioeconomic factors on drug prescriptions for psoriasis. OBJECTIVES To investigate factors influencing prescription of conventional vs. biological treatment for patients with psoriasis, based on the Italian Psocare registry, with a special focus on socioeconomic factors. METHODS This was a cross-sectional study evaluating the baseline data of patients included in the Psocare registry. All of the consecutive adult patients with a diagnosis of chronic plaque psoriasis or psoriatic arthritis who were prescribed a systemic treatment for psoriasis at participating centres were included in this study. Univariate and multivariate analyses of the baseline factors associated with a biologics prescription were performed. RESULTS From September 2005 to September 2009, 12 838 patients were identified. A multivariate analysis revealed that, among other factors, completing a level of education higher than lower secondary school and being employed as a manager or a professional were independent factors associated with a biologics prescription at entry in the registry. Additional analyses on the association between these two variables and a severe psoriasis condition [Psoriasis Area Severity Index (PASI) score > 20] revealed a significantly increasing trend of severe disease towards lower educational attainment, while unemployed patients were more likely to have a more severe condition compared with the other categories of workers. CONCLUSIONS We documented inequalities of drug prescriptions for psoriasis in Italy, with a trend towards a higher frequency of prescription for more expensive biologics in higher socioeconomic sectors of the population.
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Affiliation(s)
- L Naldi
- Centro Studi GISED, Bergamo, Italy
- Dermatology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - S Cazzaniga
- Centro Studi GISED, Bergamo, Italy
- Dermatology Department, Inselspital University Hospital, Bern, Switzerland
| | | | - E Grossi
- Villa Santa Maria Institute, Tavernerio, Italy
- Semeion Research Centre, Rome, Italy
| | - A Addis
- Department of Epidemiology, Lazio Region, Rome, Italy
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Trettel A, Spehr C, Körber A, Augustin M. The impact of age on psoriasis health care in Germany. J Eur Acad Dermatol Venereol 2017; 31:870-875. [DOI: 10.1111/jdv.14115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/21/2016] [Indexed: 12/17/2022]
Affiliation(s)
- A. Trettel
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - C. Spehr
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - A. Körber
- Department of Dermatology; University Clinic Essen; Essen Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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Calara PS, Althin R, Carlsson KS, Schmitt-Egenolf M. Regional Differences in the Prescription of Biologics for Psoriasis in Sweden: A Register-Based Study of 4168 Patients. BioDrugs 2017; 31:75-82. [PMID: 28097638 PMCID: PMC5258782 DOI: 10.1007/s40259-016-0209-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Observational studies suggest an inequitable prescription of biologics in psoriasis care, which may be attributed to geographical differences in treatment access. Sweden regularly ranks high in international comparisons of equitable healthcare, and is, in connection with established national registries, an ideal country to investigate potential inequitable access. OBJECTIVE The aim was to determine whether the opportunity for patients to receive biologics depends on where they receive care. METHODS Biologic-naïve patients enrolled in the Swedish National Register for Systemic Treatment of Psoriasis (PsoReg) from 2008 to 2015 (n = 4168) were included. The association between the likelihood of initiating a biologic and the region where patients received care was analyzed. The strength of the association was adjusted for patient and clinical characteristics, as well as disease severity using logistic regression analysis. The proportion of patients that switched to a biologic (switch rate) and the probability of switch to a biologic was calculated in 2-year periods. RESULTS The national switch rate increased marginally over time from 9.7 to 11.0%, though the uptake varied across regions. Adjusted odds ratios for at least one region were significantly different from the reference region in every 2-year period. During the latest period (2014-2015), the average patient in the lowest prescribing region was nearly 2.5 times less likely to switch as a similar patient in the highest prescribing region. CONCLUSIONS Geographical differences in biologics prescription persist after adjusting for patient characteristics and disease severity. The Swedish example calls for further improvements in delivering equitable psoriasis care.
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Affiliation(s)
- Paul S Calara
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Rikard Althin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Katarina Steen Carlsson
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, 901 87, Umeå, Sweden.
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Healthcare Provider Type and Switch to Biologics in Psoriasis: Evidence from Real-World Practice. BioDrugs 2016; 30:145-51. [PMID: 26883786 DOI: 10.1007/s40259-016-0163-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous research indicates an uneven uptake of biologics in patients with moderate-to-severe psoriasis in Sweden. Therefore, it is essential to scrutinise variations in treatment patterns. OBJECTIVE The aim of this study was to evaluate the extent to which the uptake of biologics for psoriasis differs between types of healthcare provider. METHODS Three types of provider were identified within 52 units participating in the Swedish National Registry for Systemic Psoriasis Treatment (PsoReg): university hospitals, non-university hospitals and individual practices. Biologics-naïve patients (n = 3165) were included in analyses to investigate the probability of switch to biologics. The numbers of patients fulfilling the criteria for moderate-to-severe psoriasis [Psoriasis Area and Severity Index (PASI) ≥10 and Dermatology Life Quality Index (DLQI) ≥10] among patients who switched to biologics and patients who did not switch were reported. A logistic regression model was used to calculate how healthcare provider type influenced the probability of switch to biologics whilst adjusting for patient characteristics and disease severity. RESULTS During registration, 16% of patients switched to biologics while 84% remained on conventional systemic treatment. In 7% of patients, the criteria PASI ≥10 and DLQI ≥10 was fulfilled at their last visit without switching to biologics, whereas in 10% of patients the criteria was not fulfilled prior to switch. After controlling for patient characteristics and disease severity, small or no difference in the probability of switch was observed between provider types. CONCLUSIONS Disease severity does not explain the decision to switch or not to switch to biologics for a disproportionate number of patients. There seems to be an uneven uptake of biologics in Swedish clinical practice, but the type of healthcare provider cannot explain this variation. More research is needed on what factors influence the prescription of biologics.
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