Background:Plaque-type psoriasis (PSO) is a chronic inflammatory systemic skin disease. Psoriatic arthritis (PsA) is a frequent component requiring early treatment to prevent joint damage. Guidelines recommend differentiated drug decisions for both conditions. Objective and Methods:Descriptive analysis of drug choices for patients with PSO with or without additional PsA of the German Psoriasis registry PsoBest from 2007 to 2022. Results:The analysis comprises data of 17,310 patients with PSO: 18,6% with additional PsA (PSO+PsA), mean age 47.6 (± 14.8) years, 58.8% male, mean duration of PSO 16.4 years in patients without PsA (PSO-PsA; ± 14.3), 20.6 years in PSO+PsA (± 15.3, p < 0.001). PSO-PsA and PSO+PsA patients showed a marked burden of disease: PASI (15.7 (± 10.1) and 13.9 (± 10.6, p < 0.001)); DLQI (11.7 (± 7.2) and 12.3 (± 7.6; p < 0.001)). Before registry entry, 47.0% of patients received no systemic antipsoriatic treatment. Prior systemic medications were mainly non-biologics (40.4%), 12.6% were biologics, with a significantly higher rate in PSO+PsA patients (24.7% vs 9.8%). At registry baseline, the majority of the patients received non-biologic treatment (55.9%), with significantly higher rates for PSO-PsA patients (55.9% vs 34.8%). Biologics were used in 43.9% of all patients, with a significantly higher rate in PSO+PsA patients (65.9% vs 38.8%). Three hundred and three (9.4%) of PSO+PsA patients received treatments at baseline with approval for PSO, but not explicitly for PsA. Those patients had minor active joint involvement. Conclusion:Early and effective treatment of PsA is crucial to prevent persistent damage of the joints. Although most patients received recommended systemic treatment for PSO+PsA, there is a small number of patients with prescriptions addressing mainly the inflammation of the skin and not explicitly PsA. To choose recommended medication for both entities we need to regard the entire systemic inflammation and interdisciplinary co-working should be implemented.

Background: Brodalumab, a fully human monoclonal immunoglobulin IgG2 an-tibody that binds the human interleukin 17 receptor subunit A, is available for the treatment of moderate-to-severe plaque psoriasis in Europe since September 2017, but so far there are only a few studies on its use in real-world conditions. Objectives: To assess the management of moderate-to-severe psoriasis with brodalu-mab 210 mg in daily practice after 12 and 52 weeks (W). In addition, patient profiles and treatment pathways are described. Methods: LIBERO is a prospective, multicenter, non-interventional study including adult patients with plaque psoriasis treated with brodalumab 210 mg. Results: In total, 638 patients (65% male, mean age: 49.3 +/- 14.4 years) from 148 sites in Germany were enrolled. The majority suffered from severe (51.1%) or very severe (13.1%) psoriasis according to physician global assessment (PGA0-5). When start-ing with brodalumab, 58.5% were biologic nave and 41.5% were previously treated with another biologic, mainly adalimumab (18.5%) and secukinumab (17.9%). About 74.0% of patients met the primary endpoint of an absolute PASI <= 3 at W12 (n = 618, LOCF). The mean PASI was reduced significantly as of similar to W2 from 17.2 (+/- 11.7) to 9.7 (+/- 8.8) and improved further to 3.3 (+/- 6.3) at W12 (p < 0.001). At similar to W52 85.5% of patients reached a PGA0/1-response (primary endpoint) and 54.1% patients were as-sessed as completely clear (PGA0) (both n= 399, as observed). Effectiveness of broda-lumab was confirmed in relevant subgroup analysis by previous treatment regimen. Most frequently reported adverse events were nasopharyngitis (4.6%), psoriasis (4.6%) and arthralgia (4.1%), new safety signals were not detected. Conclusion: This representative, non-interventional study confirms the short- and long-term effectiveness and safety profile of brodalumab in the management of pso-riasis in daily practice as well as in relevant treatment pathways.

Zusammenfassung Die vorliegende S3‐Leitlinie wurde auf der Basis der europäischen englischsprachigen S3‐Leitlinie unter besonderer Berücksichtigung der medizinischen Gegebenheiten im deutschsprachigen Raum und mit Ergänzungen der deutschsprachigen Vorgängerversion, entsprechend den Kriterien der AWMF, erstellt. Dieser zweite Teil der Leitlinie behandelt die systemische Therapie der atopischen Dermatitis (AD). Eingegangen wird unter anderem auf die Indikationsstellung für eine Systemtherapie bei Kindern, Jugendlichen und erwachsenen Patienten mit AD. Darüber hinaus werden alle für die AD zugelassenen Medikamente wie die Biologika Dupilumab und Tralokinumab, die Januskinase‐Inhibitoren Abrocitinib, Baricitinib und Upadacitinib sowie die konventionellen immunsuppressiven Therapien mit systemischen Glukokortikosteroiden und Ciclosporin adressiert. Systemische Off‐Label ‐Therapien werden ebenfalls behandelt. Der separat publizierte erste Teil der Leitlinie umfasst die Definition und diagnostischen Aspekte der AD, beschreibt die topische Therapie sowie nichtmedikamentöse Therapieverfahren und geht auf Aspekte bei besonderen Patientengruppen ein.

ZusammenfassungDiese S3‐Leitlinie wurde auf der Basis der europäischen S3‐Leitlinie unter besonderer Berücksichtigung der medizinischen Gegebenheiten im deutschsprachigen Raum und mit Ergänzungen der deutschsprachigen Vorgängerversion erstellt. Die interdisziplinäre Leitlinienkommission bestand aus Vertretern der Deutschen Dermatologischen Gesellschaft, dem Berufsverband der Deutschen Dermatologen, der Österreichischen Gesellschaft für Dermatologie und Venerologie, der Schweizerischen Gesellschaft für Dermatologie und Venerologie, der Deutschen Gesellschaft für Allergologie und Klinische Immunologie, der Deutschen Gesellschaft für Kinder‐ und Jugendmedizin, dem Berufsverband der Kinder‐ und Jugendärzte, der Gesellschaft für Pädiatrische Allergologie und Umweltmedizin, der Deutschen Gesellschaft für Pädiatrische Rehabilitation und Prävention, der Deutschen Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie, dem Deutschen Netzwerk Versorgungsforschung, dem Deutschen Neurodermitis Bund und dem Deutschen Allergie‐ und Asthmabund. Dieser erste Teil der Leitlinie geht auf die Definition und die diagnostischen Aspekte der atopischen Dermatitis (AD) ein, behandelt die topische Therapie sowie die nichtmedikamentösen Therapieverfahren wie die UV‐Therapie, die psychoedukative Therapie, diätische Interventionen bei AD, die Allergen‐spezifische Immuntherapie bei AD und die Komplementärmedizin. Auch behandelt dieser Teil der Leitlinie die besonderen Aspekte der AD bei Kindern und Jugendlichen, in der Schwangerschaft und in der Stillzeit sowie bei Kinderwunsch. Außerdem wird auf berufsbezogene Aspekte der AD eingegangen und die Perspektive der Patienten hervorgehoben. Der zweite, separat publizierte Teil der Leitlinie adressiert die systemische Therapie der AD.

BACKGROUND:The German S2k guideline is the first to include a checklist that captures atopic dermatitis (AD) signs and symptoms as well as the lack of treatment response to identify patients eligible for systemic therapy.OBJECTIVES:Identifying candidates for a start/switch of systemic therapy in adult AD patients in Germany by applying the S2k guideline's checklist.METHODS:In this German multicentre, cross-sectional, non-interventional study (German Clinical Trials Register number: DRKS00023296), adult patients with mild to severe AD were enrolled at dermatological outpatient clinics and offices between April and October 2021. Demographics, clinical characteristics and quality of life were collected using questionnaires during one single visit. Eligibility for a start/switch of systemic AD therapy was evaluated according to the criteria of the German S2k guideline's checklist.RESULTS:Atopic dermatitis patients (575) were included in the analysis. One hundred and sixty-four patients (28.5%) received systemic (SYS) AD therapy and 411 patients (71.5%) did not (TOP). Of the TOP therapy patients, 38.7% were eligible to start systemic AD therapy, and about half of those (49.1%), were scheduled to start systemic AD therapy. The most frequent reason deciding against a systemic therapy was the patient's wish. Although 29.3% of SYS patients were eligible for a switch according to the criteria of the German S2k guideline's checklist, the majority (81.3%) did not switch AD therapy.CONCLUSIONS:This is the first study on the implementation of the German S2k guideline's checklist in everyday care of AD patients in Germany. More than one-third of the TOP patients were identified as eligible for systemic treatment. By applying the guideline's checklist criteria, another one-third of SYS patients may have benefited from a change of current systemic therapy. The use of the German S2k guideline's checklist in routine care represents an important tool to ensure effective patient care and identify inadequately treated patients.

Background Psoriasis (Pso) and atopic dermatitis (AD) are chronic skin diseases that result in significant physical and psychological impairment, financial burden, and loss of quality of life. According to previous data, there are regional differences in healthcare. Objectives The aim was to analyse the epidemiology as well as the treatment of insured people with Pso and AD in Germany in a regional comparison. Methods Data of the insurance company Techniker Krankenkasse for the year 2019 regarding treatment prevalences as well as drug prescriptions on the regional level for all physicians were examined. Results In 2019 the overall prevalence of Pso was 2.5% (about 2 million insured people in Germany) and AD was 4.2% (about 3.6 million insured people). In Pso, new guideline-compliant drugs were frequently utilised, yet systemic glucocorticosteroids (GCS) were still disproportionally prescribed. Regionally, there were pronounced disparities with higher prescription rates of the new drugs in the north and east. Insured people with AD most frequently received topical GCS (approx. 88%), of which most were class III (66%), and significantly less frequently calcineurin inhibitors (< 10%), which also conform to guidelines. Systemically, GCS were by far most commonly used (about 25% of all insured people with drug prescriptions). Dupilumab, the only long-term drug approved in 2019, was very rarely prescribed, accounting for less than 1%. Again, large regional differences similar to Pso were found. Conclusion Pso and AD show relevant disparities and gaps in drug care in the regional comparison despite uniform national guidelines and patient needs. The barriers to appropriate modern pharmaceuticals need to be clarified and mitigated.

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke. Objectives In this study, AD characteristics and its atopic comorbidities are compared in smoking and non-smoking AD patients. Methods TREATgermany is a non-interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included in TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analysed comparing AD disease characteristics and comorbidities in smokers vs. non-smokers. Results Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 +/- 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n = 352; 38.8%) and non-smokers, however, lesions' intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to non-smoking patients. Smokers reported a lower number of weeks with well-controlled AD and more severe pruritus than non-smokers. Total IgE levels were more elevated in smokers and they displayed a younger age at the initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well-controlled AD and the greater pruritus remained different in smokers compared to non-smokers. In addition, smoking patients with adult-onset AD showed a 2.5 times higher chance of involvement of the feet. Conclusions German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult-onset AD.

The disease-related costs of psoriasis are of considerable importance, as the drug expenses for psoriasis in Germany have risen continuously in recent years. Overall, the economic burden of psoriasis markedly depends on disease-specific characteristics such as severity and comorbidity. Furthermore, there are differences in the healthcare costs between patients treated with biologics compared to those using traditional systemic treatments..

The data that support the findings of this analyses are available from the corresponding author upon reasonable request.

Einleitung Atopische Dermatitis (AD) geht als chronische Hauterkrankung nicht nur mit lebenslangen, sondern auch mit für Betroffene schwer abzuschätzenden, individuellen Krankheitsverläufen und Begleitsymptomatik einher. Der Beitrag untersucht den Zusammenhang objektiver Erkrankungsschwere mit subjektivem Erleben von Fatigue bei Patient*innen mit moderater bis schwerer AD aus dem Register TREATgermany zur Baselinevisite.

BACKGROUND:In the study series PsoHealth first data from 2004/05 showed a poor quality of health care for psoriasis in Germany. Most patients lacked sufficient care and only a minor proportion received systemic drugs. Since 2007, a national psoriasis programme has been conducted. OBJECTIVES:(1) To analyse the quality of health care for psoriasis in the most recent PsoHealth4 survey 2016/17, (2) to compare health care quality indicators with prior assessments since 2004/05. MATERIALS AND METHODS:The recent cross-sectional PsoHealth4 survey was conducted 2016/17, and three preceding studies were performed in 2004/05, 2007 and 2013/14, each including at least 1500 patients. The common set of quality indicators included disease severity (PASI and proportion of patients with PASI > 20, indicating high severity), quality of life (DLQI and proportion of patients with DLQI > 10, indicating strong impairments in quality of life), systemic therapy and inpatient treatment of the last five years. RESULTS:Between December 2015 and December 2017, n = 1827 patients from 93 dermatological centres were included in the most recent survey (mean age: 50.8 ± 14.6 years, 45.2% female). 7.3% showed a PASI > 20, compared to 17.8% in 2004/05. 21.4% reported a DLQI > 10, compared to 34.0% in 2004/05. 57.6% of all participants stated to have received a systemic therapy at least once within the last five years, compared to 32.9% in 2004/05. 18.0% received inpatient hospital treatment at least once within the last five years, compared to 26.9% in 2004/05. CONCLUSION:A remarkable improvement in the health care quality for psoriasis patients in Germany within the past 12 years can be assumed. Major determinants could be the innovation shift which included programmes such as the S3 guideline, a consensus on treatment goals, national health care goals for psoriasis and higher utilisation of innovative drugs.