title: Does the treatment ladder for systemic therapy in moderate to severe psoriasis only go up? The percentage of patients with severe psoriasis on biologics increases over time.
abstract: BACKGROUND
  With the advent of biologic drugs in the management of moderate to severe psoriasis, there may have been a shift in therapeutic approach from rotational strategies to a unidirectional progression from topical treatments to the highest rung of the therapeutic ladder. We studied the frequency of switching from classic to biologic therapy and vice versa in a cohort of patients with psoriasis over a period of up to 5 years.
  
  
  METHODS
  Patients are included in the BIOBADADERM prospective registry when they are first prescribed any specific conventional or biologic systemic treatment. The data for each patient refer to the follow-up period from the time they entered the cohort until October 2013. To describe the pattern of switches from classic to biologic therapy and vice versa, we used the data in the registry on the first day of every 365-day period following the date each patient was included in the cohort.
  
  
  RESULTS
  In total, 47.3% of the patients (926/1956) were prescribed a classic systemic drug and 52.7% (1030/1956) a biologic agent on entry into the study. Of the 741 patients who accumulated 5 years of follow-up, 21.9% (155) were receiving nonbiologic drugs and 78.1% (553) were on biologic therapy on the first day of their 5th year of follow-up.
  
  
  CONCLUSIONS
  The proportion of patients receiving biologic therapy increased with longer follow-up.
authors.affiliation: Hospital Universitari Germans Trías i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: jmcarrascosac@hotmail.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Carrascosa
authors.affiliation: Hospital Universitari Germans Trías i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Rivera
authors.affiliation: Research Unit, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Garcia-Doval
authors.affiliation: Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Carretero
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Vanaclocha
authors.affiliation: Hospital Universitario la Princesa, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Daudén
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Gómez-García
authors.affiliation: Hospital Infanta Leonor, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: De-la-Cueva-Dobao
authors.affiliation: Hospital Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Herrera-Ceballos
authors.affiliation: Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Belinchón
authors.affiliation: Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Alsina
authors.affiliation: Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Sánchez-Carazo
authors.affiliation: Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Ferrán
authors.affiliation: Hospital Universitario Fundación de Alcorcón, Madrid, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Lopez-Estebaranz
authors.affiliation: Research Unit, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain; Hospital Universitario de Albacete, Albacete, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Pérez-Zafrilla
authors.affiliation: Hospital Universitario la Princesa, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Llamas
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Rivera
authors.affiliation: Hospital Universitari Germans Trías i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Ferrándiz
mesh_terms: D001688:Biological Products / Q000627:therapeutic use; D016022:Case-Control Studies; D003879:Dermatologic Agents / Q000145:classification / Q000627:therapeutic use*; D003880:Dermatology / Q000639:trends*; D057915:Drug Substitution / Q000639:trends; D004363:Drug Utilization / Q000639:trends; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D013030:Spain
chemical_list: D001688:Biological Products; D003879:Dermatologic Agents
keywords: Biologic; Biológico; Convencional; Conventional; Psoriasis; Sistémico; Systemic; Therapy; Tratamiento