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The higher proportion of men with psoriasis treated with biologics may be explained by more severe disease in men
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0003-3298-1555
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.ORCID iD: 0000-0002-3858-8474
2013 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 5, e63619- p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Moderate to severe psoriasis, once regarded as merely a skin disease, is today seen as an inflammatory systemic disease. The sex ratio of the prevalence of psoriasis is balanced. In recent years several reports have documented that men receive more systemic or UV treatment than women, and different hypotheses were made. In PsoReg, the national registry for systemic treatment of psoriasis in Sweden, we have, like other European registries, observed a predominance of men (59%), especially of men treated with biologics (63%). Biologics are a relatively new group of very effective but high-priced drugs. The objective of this study was to analyse if women are discriminated by not having the same access to the high-priced biologics.

DESIGN: Population based cohort study using data from a nationwide quality register of psoriasis patients.

POPULATION: 2294 patients with moderate to severe psoriasis receiving systemic treatment from a specialist in dermatology.

MAIN OUTCOME MEASURES: Time to initiation of biologic treatment. A multiple Cox proportional hazard's regression was performed, with time to initiating a biologic treatment as the outcome in order to assess the independent role of the patient's sex in initiating such therapy. The psoriasis severity was defined as a time-varying variable.

RESULTS: Men had more severe psoriasis than women according to the Psoriasis Area and Severity Index (PASI), regardless of age at enrolment, and throughout the study period. The analysis in the multiple Cox regression show that age, psoriasis severity and psoriasis arthropathy were relevant factors for initiating biologic therapy, whereas sex is not.

CONCLUSIONS: Although as many women as men are believed to suffer from psoriasis, men seem to be more severely affected by psoriasis. The asymmetry in allocation of biologic therapy thereby probably reflects the differing disease activity between the sexes, and is not a discrimination against women per se.

Place, publisher, year, edition, pages
Public library of science , 2013. Vol. 8, no 5, e63619- p.
Keyword [en]
system; index; area; risk
National Category
Dermatology and Venereal Diseases
Identifiers
URN: urn:nbn:se:umu:diva-71355DOI: 10.1371/journal.pone.0063619ISI: 000319052700054PubMedID: 23691076OAI: oai:DiVA.org:umu-71355DiVA: diva2:623346
Available from: 2013-05-27 Created: 2013-05-27 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Psoriasis in Sweden: observational studies from an epidemiological perspective
Open this publication in new window or tab >>Psoriasis in Sweden: observational studies from an epidemiological perspective
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Psoriasis i Sverige : observationella studier ur ett epidemiologiskt perspektiv
Abstract [en]

Background: Psoriasis is a heterogeneous disease with several clinical manifestations; the symptoms are characterized by redness, scaliness and thickness of the skin. There are several treatment options available for psoriasis and patients with moderate to severe psoriasis generally need systemic agents. In 2004 biologics were introduced for patients with moderate to severe psoriasis in Sweden.

Methods: The Swedish Health Care Registers and the Swedish registry for systemic treatment of psoriasis PsoReg, were used to; estimate the incidence of psoriasis cases in the Swedish specialist care, to examine the treatment allocation and important factors related to the initiation of especially biologic treatment.

Results: On average 9000 new psoriasis patients entered specialist care in Sweden each year under study, corresponding to an incidence of 98 patients per 100,000 person-years. In the treatment allocation analysis of the incident psoriasis cases in the Swedish specialist care Patients living in a Metropolitan Area and with a University degree were more likely to initiate a biologic treatment. By analysing biologic-naïve patients enrolled in PsoReg, PASI (the physician’s assessment of the psoriasis severity) and Psoriasis Arthropathy were shown to be two important factors associated with the initiation of biologic treatment while sex was not. Furthermore, it was also shown that the decision to initiate biological treatment was more strongly associated with PASI than with DLQI (the patients’ assessment of the disease impact Quality of Life).

Conclusion: These studies indicate that there are inequalities in the assignments of systemic psoriasis treatments (especially in biologic treatment). Since the allocation of treatments should not depend on sex, education or residency in a Metropolitan Area but rather the need of care, it is important that future studies continue analysing possible factors that could influence the initiation of treatment in clinical practice.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2016. 48 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1776
Keyword
Psoriasis, Systemic treatments, Biologic treatments, PASI, DLQI, Register-based research
National Category
Dermatology and Venereal Diseases
Research subject
Dermatology and Venerology
Identifiers
urn:nbn:se:umu:diva-113894 (URN)978-91-7601-402-8 (ISBN)
Public defence
2016-01-22, Sal E04, byggnad 6E, Norrlands Universitetsjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-01-08 Created: 2016-01-05 Last updated: 2016-01-07Bibliographically approved

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Hägg, DavidEriksson, MarieSchmitt-Egenolf, Marcus

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