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January 30, 2017

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Psoriasis - so many new biologics available but still so undertreated...why?

January 30, 2017

 

Psoriasis is an inflammatory skin disease, with a strong genetic basis, that typically follows a relapsing and remitting course.

 

The prevalence of psoriasis is estimated to be around 1.3–2.2% in the UK.

 

Psoriasis is associated with joint disease in approximately 25% of patients.

 

Psoriasis can occur at any age, although is uncommon in children (0.71%) and the majority of cases occur before 35 years of age. Psoriasis for many people results in profound functional, psychological, and social morbidity, with consequent reduced levels of employment and income.

Historically treatments have been limited to topical , often smelly and inconvenient preparations that have been effective for mild psoriasis and for some symptomatic relief but for moderate to severe psoriasis systemic treatments after phototherapy were limited to methotrexate and cyclosporine.

 

But in the last few years biologic agents have been introduced with good success rates enabling patients to get back on with life and not been defined by thier psoriasis.

 

NICE have issued guidance for the use of biologics in this pathway and all patients that "qualify" for a biologic should be able to access. Just last year two new biologics were licensed for Psoriasis and there is expected to be more over the next couple of years. When patients fail on one drug in most areas of the country they can be tried on one or two more biologics before facing any funding hurdles.

BUT, we know that the use of biologics in psoriasis is below the level that would be expected in the given the incidence and prevalence.

From recent work carried out at Lancaster Hammond we know that some of the reasons for this could be:

  1. Lack of dermatology education in the primary care setting leading to underdiagnosis.

  2. Prioritisation of skin cancer patients in dermatology clinics leading to long waiting times for dermatology referrals

  3. Resourcing in dermatology departments and especially the support for specialist nurses who are able to routinely conduct the scoring tests regarding disease severity and quality of life. (PASI and DLQI)

  4. No CQUINS or financial incentives in the psoriasis patient pathway

  5. No guidance from NICE , BAD or national body in order to identify the most appropriate biologic for patient profile and disease state.

  6. No guidance from NICE, BAD or national body regarding the use of consecutive biologics on treatment failure or side effects.

Psoriasis is a debilitating disease both physically and psychologically and with the new raft of biologics available now and the potential "game changers" on the horizon isn't it about time that patients can be identified and treated in the most effective way?

 

Lancaster Hammond have a great deal of expertise in immunology and can identify market access and market optimisation opportunities for any organisation trying to optimise the use of drugs or devices within these patient pathways. For a no obligation chat please contact debbie@lancasterhammond.co.uk.

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