>> There is no talk of a storm surge like the one recently caused by the hurricane “Herwart” when it comes to psoriasis, but this disease, among the 12,000 listed by the WHO, is at least one of the 3 with “Major WHO demands” - along with that Main requirement of stopping stigmatization and access to adequate treatment. In Germany, according to epidemiological figures, Univ.-Prof. Dr. However, Matthias Augustin, director of the Institute for Health Services Research in Dermatology and Nursing Professions (IVDP), presented a 2.5 percent annual prevalence. This means that around 2 million people suffer from psoriasis (Pso), commonly known as psoriasis - including around 400,000 with moderate to severe Pso, around 120,000 affected children and adolescents and around 200,000 people with psoriatic arthritis.
Little has changed in the care of psoriasis in Germany for years. A current update from this year shows roughly the same distribution as described in 2012 (1). Accordingly, 65 % of pso and 59 % of pso arthritis patients are cared for by dermatologists, the rest of 29 %
(18) by general practitioners, another 3 % (18) by rheumatologists and another 3 % (4) by other health professionals. This care structure has an impact on the quality of treatment, especially medication. Augustin notes a “continuing specialization among dermatologists”, with 30 %s from this specialist group prescribing 100 %s of the innovative medications. In this indication in particular - unlike many others - there are a whole lot of them: starting with systemic “conventional” first-line therapy with fumaric acid ester, methotrexate, ciclosporin and acitretin and continuing to systemic “biological” first-line therapy with adalimumab, brodalumab, ixekizumab, secukinumab and guselkumab, launched in December 2017. There is also systemic second-line therapy (apremilast (no Biologic), etanercept + biosimilars, infliximab + biosimilars and ustekinumab) (3) .
But what does the rest prescribe? Not what would be possible and sensible! The frequency of prescription in systemic “conventional” first-line therapy drops drastically from the frequently prescribed, inexpensive fumaric acid esters to the rarely used acitretin.
For example, data from the Spanish registry “BioCAPTURE” shows that so-called “drug survival” decreases dramatically the less innovative drugs are. Prof. Dr. med. Ulrich Mrowietz from the Psoriasis Center, Dermatology Department, at the University Hospital Schleswig-Holstein on the Kiel Campus, came to the conclusion: “Treat successfully for a long time!” And: “Treat particularly effectively”.
A study on the interleukin 17A antagonist using ixekizumab as an example showed that after around 24 weeks, a PASI 75 could be determined in 83 % of the patients examined and a PASI 90 could still be determined in 75 % (5).
Good medication pays off. A comparison of the studies “PsoHealth1” from 2005 to “PsoHealth2” (2008), “PsoHealth3” (2011) and the current “PsoHealth4” from last year 2016 shows in this context that both the mean of the PASI and that the DLQI* fell: from 11.4 (8.6) in 2005 to 7.2 (5.6) in 2016; as did the hospitalization rate from 26.9 to 14.2 over the same period. Augustin's conclusion on this: "This means that those affected who receive drug therapy in accordance with guidelines have a significantly higher chance of healing of the skin."
If only everyone affected received them equally. The reality of care is different: According to Augstin, only around 45 % of severe psoriasis in Germany are considered “adequately cared for”, but around 55 %
inadequate or incorrect care (2). And this despite the fact that drug consumption increased by 218 % compared to 2015. But in a nationwide comparison it is also quite different. A new data comparison based on 2015-2016 (as of March 2017) lists, for example, the per capita expenditure for biologics prescribed by contract doctors for psoriasis in Germany. According to this, most biologics are prescribed in the KV Brandenburg area: for 4.50 euros (2015) rose to 6.00 euros (2016). The KV Baden-Württemberg, on the other hand, is at the bottom, although it also has an increase, but at a completely different level - from 0.60 euros (2011) to 0.85 euros (2016). In Augustin's opinion, when it comes to biological therapy for psoriasis, it can certainly be said that “large freedom of appearance is the realistic therapeutic goal today”.
If only the available medication were used - a patient's place of residence is fate; apparently especially in Baden-Württemberg, where the biologics regulations are a factor of 10 and the Fumaderm regulations are still a factor of 3 lower than in many other federal states, especially those in eastern Germany. <<.