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- Calara, Paul S., et al.
(författare)
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Healthcare Provider Type and Switch to Biologics in Psoriasis : Evidence from Real-World Practice
- 2016
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Ingår i: BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy. - : Springer Science and Business Media LLC. - 1173-8804 .- 1179-190X. ; 30:2, s. 145-151
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Tidskriftsartikel (refereegranskat)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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- Calara, Paul S, et al.
(författare)
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Regional Differences in the Prescription of Biologics for Psoriasis in Sweden : a Register-Based Study of 4168 Patients
- 2017
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Ingår i: BioDrugs. - : Springer Science and Business Media LLC. - 1173-8804 .- 1179-190X. ; 31:1, s. 75-82
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Tidskriftsartikel (refereegranskat)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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- Gaele, Kirk, et al.
(författare)
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Evaluating equality in psoriasis healthcare : a cohort study of the impact of age on prescription biologics
- 2016
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Ingår i: British Journal of Dermatology. - : Oxford University Press (OUP). - 0007-0963 .- 1365-2133. ; 174:3, s. 579-587
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Inequality in healthcare has been identified in many contexts. To the best of our knowledge, this is the first study investigating age inequity in the form of prescription patterns of biologics in psoriasis care.OBJECTIVE:To determine whether psoriasis patients have equitable opportunities to receive biologic medications as they age. If patients do not receive equitable treatment, a subsequent objective is to determine the magnitude of the disparity.METHODS:A cohort of biologic-naïve psoriasis patients were analysed using Cox proportional hazard models to measure the impact of each additional year of life on the likelihood of initiating biologic treatment, after controlling for sex, body mass index, comorbidities, disease activity, and education level. A supporting analysis used a non-parametric graphical method to study the proportion of patients initiating biologic treatment as age increases, after controlling for the same covariates.RESULTS:The Cox proportional hazards model results in a hazard ratio of a one year increase in age of 0.963 to 0.969 depending on calendar year stratification, which implies that an increase in age of 30 years corresponds to a reduced likelihood of initiating biologic treatment by 61.3-67.6%. The estimated proportion of patients initiating biologic medication is always decreasing as age increases, at a statistically significant level.CONCLUSIONS:Psoriasis patients have fewer opportunities to access biologic medications as they age. This result was shown to be applicable at all stages in a patient's life course and was not only restricted to the elderly, although it implies greater disparities as the age difference between patients increases. These results show that inequity in access to biologic treatments due to age is prevalent in clinical practice today. Further research is needed to investigate the extent to which this result is influenced by patient preferences.
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- Geale, Kirk, et al.
(författare)
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How is disease severity associated with quality of life in psoriasis patients? : Evidence from a longitudinal population-based study in Sweden
- 2017
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Ingår i: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525 .- 1477-7525. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Assessing the impact of disease severity on generic quality of life (QOL) is a critical step in outcomes research and in the development of decision-analytic models structured around health states defined by clinical measures. While data from routine clinical practice found in healthcare registers are increasingly used for research, more attention should be paid to understanding the relationship between clinical measures of disease severity and QOL. The purpose of this work was therefore to investigate this relationship in psoriasis using a population-based dataset.METHODS: Severity was measured by the Psoriasis Area and Severity Index (PASI), which combines severity of erythema, induration, and desquamation into a single value ranging from 0 to 72. The generic EQ-5D-3L utility instrument, under the UK tariff, was used to measure QOL. The association between PASI and EQ-5D-3L was estimated using a population-based dataset of 2674 patients with moderate to severe psoriasis enrolled over ten years in the Swedish psoriasis register (PsoReg). Given the repeated measurement of patients in the register data, a longitudinal fixed-effects model was employed to control for unobserved patient-level heterogeneity.RESULTS: Marginal changes in PASI are associated with a non-linear response in EQ-5D-3L: Moving from PASI 10 to 9 (1 to 0) is associated with an increase of 0.0135 (0.0174) in EQ-5D-3L. Furthermore, unobserved patient-level heterogeneity appears to be an important source of confounding when estimating the relationship between QOL and PASI.CONCLUSIONS: Using register data to estimate the impact of disease severity on QOL while controlling for unobserved patient-level heterogeneity shows that PASI appears to have a larger impact on QOL than previously estimated. Routine collection of generic QOL data in registers should be encouraged to enable similar applications in other disease areas.
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- Hjalte, Frida, et al.
(författare)
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Real-world outcome analysis of continuously and intermittently treated patients with moderate to severe psoriasis after switching to a biologic agent
- 2015
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Ingår i: Dermatology. - : S. Karger. - 1018-8665 .- 1421-9832. ; 230:4, s. 347-353
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clinical studies of continuous versus intermittent biologic therapy for moderate to severe psoriasis demonstrate improved efficacy with continuous treatment. Objective: To analyse Swedish real-world data of continuously and intermittently treated biologic-naive patients after switching to a biologic agent. Methods: This is an observational study based on PsoReg, the Swedish registry for systemic psoriasis treatment. Outcome effects in biologic-naive patients who switched to a biologic agent (n = 351) were analysed in groups of continuous, intermittent and terminated treatment. Results: Intermittently treated patients (n = 50) reported higher Psoriasis Area and Severity Index and Dermatology Life Quality Index values after switching than patients with continuous (n = 260) or terminated treatment (n = 41). Study Limitations:The reason for intermittent treatment was not recorded. The intermittently treated patients may be a heterogeneous group and a limitation is that it cannot be determined whether less than continuous use was offered to handle negative aspects. Conclusion: Patients with continuous biologic treatment tend to achieve better outcomes compared to intermittently treated patients.
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- Hjalte, F., et al.
(författare)
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Sustained Psoriasis Area and Severity Index, DermatologyLife Quality Index and EuroQol-5D response of biologicaltreatment in psoriasis : 10 years of real-world data in theSwedish National Psoriasis Register
- 2018
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Ingår i: British Journal of Dermatology. - Hoboken : John Wiley & Sons. - 0007-0963 .- 1365-2133. ; 178:1, s. 245-252
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Few studies have analysed the long-term effects of biological treatment in psoriasis. PsoReg, the Swedish national register for systemic psoriasis treatment, started in 2006 and includes now ten years of real-world data on effectiveness of biological treatment.OBJECTIVE: To analyse long-term real-world outcome data on biological-naïve patients with moderate to severe psoriasis after switching to biological treatment.METHODS: Observational study including biological-naïve patients with at least one registration of outcome before switching to biological treatment while included in PsoReg and at least one follow-up visit. PASI, DLQI and EQ-5D values were analysed at 3-5 months, 6-11 months, and at least once 1 year and above, up to 9 years after switch to biological treatment.RESULTS: 583 patients fulfilled the inclusion criteria. Of these, 399/395/373 patients had observed outcome data beyond one year on PASI/DLQI/EQ-5D, respectively, and 164/168/152 were observed in at least three time periods after switch. Significant (p<0.01) improvement in PASI, DLQI and EQ-5D was observed 3-5 months after switch and sustained under the whole observation period. Mean PASI/DLQI/EQ-5D changed from 13.5 (SD 9.1)/9.0 (SD 8.1)/0.737 (SD 0.222), respectively, before switch, to 4.0 (SD 3.5)/3.7 (SD 4.7)/0.792 (SD 0.208), respectively, 1-5 years after switch.CONCLUSION: Biological treatment, as used in clinical practice, show a stable long term effectiveness in all measured dimensions: PASI, DLQI and EQ-5D.
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