OBJECTIVES: Psoriasis is a chronic, inflammatory skin condition affecting 2-3% of the global population. In the Finnish public health care system, mild psoriasis is typically treated in primary care settings, while severe cases, often requiring the use of systemic treatments, are managed in hospital outpatient settings. The aim of our study is to characterize psoriasis patients and treatment patterns at two major Finnish hospital districts from 2013 to 2021.

METHODS: Psoriasis patients were eligible for cohort inclusion if they were (1) diagnosed between 2013 to 2021 and (2) treated in the Hospital Districts of Helsinki and Uusimaa or Southwest Finland. Services, demographic characteristics, and drug purchases were collected from the hospital and national registers. Patient index date was defined as the earliest date of recorded diagnosis code (ICD-10 L40) or reimbursement for a psoriasis treatment. Descriptive characteristics and uptake of systemic therapies were summarized. Time to therapy initiation and treatment duration were assessed using Kaplan-Meier analyses.

RESULTS: Between 2013 and 2021, 7,086 patients were diagnosed with psoriasis in a public specialty care setting. The median time from diagnosis in the specialty care setting to systemic treatment initiation was approximately 5 years. Per reimbursement guidelines, patients received conventional systemics (typically methotrexate or acitretin) before initiating biologics or apremilast. Median drug survival for the first systemic treatment was 103 days (95% CI: 87-113). Only 19% of patients initiated a biologic within 5 years of conventional systemic initiation. Median drug survival for the first biologic therapy was 552 days (95% CI: 448-671).

CONCLUSIONS: Conventional systemic therapies are the first line therapy for most patients with advanced psoriasis in specialty care settings consistent with prescribing guidelines. Significant numbers of patients who receive conventional systemics do not receive biologic therapy for several years and receive conventional therapies as a second line or later treatment.