title: Real-world outcomes in 2646 psoriasis patients: one in five has PASI ≥10 and/or DLQI ≥10 under ongoing systemic therapy.
abstract: BACKGROUND
  Although biologics introduced a new era in psoriasis care when available a decade ago, it is unclear to what extent the available systemic treatments treat patients adequately.
  
  
  OBJECTIVE
  To analyse the clinical severity and quality of life of the psoriasis population in Sweden treated with systemics.
  
  
  METHODS
  Data included 2646 patients from the Swedish Registry for Systemic Treatment of Psoriasis. Average Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and EQ-5D were reported. A subgroup of persisting moderate-to-severe psoriasis as defined by PASI ≥10 and/or DLQI ≥10 after >12 weeks treatment was analysed.
  
  
  RESULTS
  Mean (SD) PASI, DLQI and EQ-5D were 4.12 (4.57), 4.11 (5.24) and 0.79 (0.22). Eighteen percent had persisting moderate-to-severe psoriasis (n = 472). These patients were younger, had higher BMI, had psoriasis arthritis and were smoking to a larger extent (p < 0.01) compared with lower-severity patients (n = 2174). Mean (SD) EQ-5D was also considerably lower 0.63 (0.29) vs. 0.82 (0.19) (p < 0.01).
  
  
  CONCLUSIONS
  Almost one in every five patients had persisting moderate-to-severe psoriasis, despite ongoing systemic treatment. Both comorbidities and life style factors were associated with persisting moderate-to-severe psoriasis. The considerably lower generic quality of life in these patients demonstrates an unmet need. Subsequently, improved access to biologics and continuous drug development is needed in psoriasis.
authors.affiliation: a The Swedish Institute for Health Economics (IHE) , Lund , Sweden.
authors.forename: J M
authors.identifier: http://orcid.org/0000-0001-5402-1884
authors.initials: JM
authors.lastname: Norlin
authors.affiliation: a The Swedish Institute for Health Economics (IHE) , Lund , Sweden.
authors.forename: P S
authors.identifier: http://orcid.org/0000-0002-7457-3392
authors.initials: PS
authors.lastname: Calara
authors.affiliation: a The Swedish Institute for Health Economics (IHE) , Lund , Sweden.|b Lund Institute of Economic Research, School of Economics and Management, Lund University , Lund , Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Persson
authors.affiliation: c Department of Public Health and Clinical Medicine, Dermatology , Umeå University , Umeå , Sweden.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-3858-8474
authors.initials: M
authors.lastname: Schmitt-Egenolf
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003879:Dermatologic Agents / Q000627:therapeutic use; D004334:Drug Administration Schedule; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy / Q000473:pathology*; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index; D000069549:Ustekinumab
chemical_list: D003879:Dermatologic Agents; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate
keywords: DLQI; EQ-5D; PASI; Psoriasis