Svedbom A, Dalén J, Mamolo C, Cappelleri J C, Petersson I F, Ståhle M
OptumInsight, Stockholm, Sweden.
Unit of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
J Eur Acad Dermatol Venereol. 2015 Feb;29(2):215-223. doi: 10.1111/jdv.12494. Epub 2014 May 12.
Little data exist on real-world treatment patterns in psoriasis, especially from European settings.
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.
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.
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.
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.
关于银屑病实际治疗模式的数据很少，尤其是来自欧洲地区的数据。
基于登记数据，估计瑞典接受各类治疗的银屑病患者使用外用药物、系统药物和生物制剂后出现治疗不持续、换药、增加用药及治疗效果不佳（仅针对生物制剂）的时间，以及重新开始治疗的时间。
该数据库分析利用了来自瑞典多个行政登记处的银屑病患者数据。通过两个地区登记处的诊断组合以及瑞典处方药登记处的相关治疗处方来识别患者。以相关治疗事件为失败事件，估计Kaplan-Meier事件发生时间（“生存”）函数，并从失败率得出特定时间点经历事件的患者比例。
外用药物、系统药物和生物制剂的索引治疗次数分别为25396次、2963次和628次。治疗开始一年后，外用药物、系统药物和生物制剂治疗不持续的患者比例分别估计为88.3%、47.9%和43.2%。在持续治疗的患者中，治疗开始后1年内外用药物、系统药物和生物制剂增加用药的治疗次数比例分别估计为56.0%、45.3%和58.9%。此外，在治疗不持续的1年内，49.0%的外用药物、60.8%的系统药物和80.2%的生物制剂治疗次数重新开始，根据治疗类别，35.4%-52.
