title: Systemic treatment with corticosteroids in psoriasis--health care provision far beyond the S3-guidelines.
abstract: BACKGROUND
  The basis of induction therapy for psoriasis in Germany is the S3-guideline which for moderate to severe psoriasis recommends the systemic agents fumaric acid esters, methotrexate, cyclosporine and the biologicals infliximab, etanercept, adalimumab and ustekinumab. Systemic glucocorticosteroids (GCS) are not proposed.
  
  
  OBJECTIVE
  To what extend are systemic glucocorticosteroids prescribed in psoriasis therapy?
  
  
  METHODS
  The database of a German nationwide statutory health insurance 2007 was analyzed. Prescriptions of systemic glucocorticosteroids were identified by ATC-encoding. Psoriasis patients with comorbidities requiring systemic glucocorticosteroid medication were analyzed separately.
  
  
  RESULTS
  Among 1,423,308 continuously insured patients in 2007 n = 34,728 (2.4 %) were patients with psoriasis. The most prescribed systemic agents were corticosteroids (2774 patients), followed by methotrexate (853), fumaric acid esters (342), retinoids (110) and cyclosporine A (105). Even after excluding patients with psoriatic arthritis, systemic corticosteroids were still the most often prescribed systemic drugs. The average number of DDD (Defined Daily Doses) per insured patient was 120 (general practitioners), 141 (internists) and 68 (dermatologists). These results were confirmed by a control analysis with IMS data.
  
  
  CONCLUSIONS
  In Germany, psoriasis is often treated with systemic corticosteroids though these are not recommended by the S3-guideline. General practitioners and internists are the main prescribers.
authors.affiliation: CVderm-Competence Center for Health Services Research in Dermatology, University Clinic Hamburg-Eppendorf, Germany. m.augustin@uke.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Augustin
authors.forename: Ines
authors.initials: I
authors.lastname: Schäfer
authors.forename: Kristian
authors.initials: K
authors.lastname: Reich
authors.forename: Gerd
authors.initials: G
authors.lastname: Glaeske
authors.forename: Marc
authors.initials: M
authors.lastname: Radtke
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D016572:Cyclosporine / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005650:Fumarates / Q000627:therapeutic use; D058006:General Practice; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D056687:Off-Label Use / Q000706:statistics & numerical data*; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy*; D012176:Retinoids / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D005650:Fumarates; D012176:Retinoids; D016572:Cyclosporine; D008727:Methotrexate