title: Treatment patterns with topicals, traditional systemics and biologics in psoriasis - a Swedish database analysis.
abstract: BACKGROUND
  Little data exist on real-world treatment patterns in psoriasis, especially from European settings.
  
  
  OBJECTIVE
  To estimate, for topicals, systemics and biologics, the time to non-persistency, switching, augmentation and insufficient treatment result (only for biologics), as well as to estimate the time to restart, in patients treated with each treatment class in Sweden based on registry data.
  
  
  METHODS
  This database analysis utilized data from patients with psoriasis from several Swedish administrative registers. Patients were identified through combinations of diagnoses from two regional registers and filled prescriptions for relevant treatments from the Swedish Prescribed Drug Register. Kaplan-Meier time-to-event ('survival') functions were estimated with relevant treatment events as failure and the proportions of patients having experienced an event at specific time-points were derived from the failure rates.
  
  
  RESULTS
  For topicals, systemics and biologics the number of indexed treatment episodes were 25,396, 2963, and 628 respectively. One year after treatment initiation, the proportion of patients who were classed as non-persistent with topicals, systemics and biologics were estimated at 88.3%, 47.9% and 43.2% respectively. Among patients who remained persistent, within 1 year of treatment start the proportions of treatment episodes in which patients were augmented were estimated at 56.0% for topicals, 45.3% for systemics and 58.9% for biologics. In addition, within 1 year of non-persistence, 49.0% of topicals, 60.8% of systemics and 80.2% of biologics treatment episodes were re-initiated, with 35.4-52.5% re-initiated on the non-persistent treatment depending on treatment class. In addition, among patients on biologics, 29.2% of treatment episodes had an insufficient treatment result within 1 year of treatment start.
  
  
  CONCLUSIONS
  Persistency to psoriasis treatments may be sub-optimal and patients who remain persistent relatively frequently receive augmentation therapy or switch to another therapy. Therefore, current treatment options in psoriasis may be insufficient.
authors.affiliation: OptumInsight, Stockholm, Sweden.|Unit of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Svedbom
authors.affiliation: OptumInsight, Stockholm, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Dalén
authors.affiliation: Pfizer Inc., Groton, CT, USA.
authors.forename: C
authors.initials: C
authors.lastname: Mamolo
authors.affiliation: Pfizer Inc., Groton, CT, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Cappelleri
authors.affiliation: Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
authors.forename: I F
authors.initials: IF
authors.lastname: Petersson
authors.affiliation: Unit of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Ståhle
mesh_terms: D000287:Administration, Topical; D001688:Biological Products / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology; D012042:Registries; D013548:Sweden / Q000453:epidemiology
chemical_list: D001688:Biological Products