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Healthcare Provider Type and Switch to Biologics in Psoriasis: Evidence from Real-World Practice

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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.


The aim of this study was to evaluate the extent to which the uptake of biologics for psoriasis differs between types of healthcare provider.


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.


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.


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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The authors would like to thank all patients and healthcare professionals for using and advancing PsoReg.

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Correspondence to Marcus Schmitt-Egenolf.

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Ethical approvals

Research was done in adherence to the Declaration of Helsinki; informed consent was obtained from all individual participants included in the study. Data and consent are collected electronically, to assure effective logistics in this nationwide project. The Umeå Ethical Review Board (Umeå, Sweden) approved the project and the procedure for patient consent.


PsoReg receives financial support from the Swedish Board of Health and Welfare, Swedish Association of Local Authorities and Regions and Västerbotten County Council. The research has received financial support from Abbvie, Janssen Cilag, Leo Pharma, Novartis and Pfizer. Sponsors had no access to data. None of the authors has any conflict of interest in connection to the article. The authors had full independence regarding data collection, manuscript preparation, decision to publish, study design, interpretation and analysis.

Conflicts of interest

P. S. Calara, J. M. Norlin, R. Althin, K. Steen Carlsson and M. Schmitt-Egenolf have no further conflicts of interest to declare.

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Calara, P.S., Norlin, J.M., Althin, R. et al. Healthcare Provider Type and Switch to Biologics in Psoriasis: Evidence from Real-World Practice. BioDrugs 30, 145–151 (2016).

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