Activities on Psoriasis in 2009 – the Division of Evidence based Medicine in Dermatology (Berlin / Germany)

Activities on Psoriasis in 2009 – the Division of Evidence based Medicine in Dermatology (Berlin / Germany) developed new guidelines and performed health care research

The division of Evidence Based Medicine (dEBM) (head: Prof. B. Rzany MD ScM) is located at the Department of Dermatology at the Charité Universitätsmedizin in Berlin, Germany. The dEBM is coordinating the development of evidence based (S3 Guidelines) on national and international levels.

1) European evidence based psoriasis guidelines were published in autumn 2009

The development of the first European evidence based guidelines for the treatment of plaque psoriasis was finalized and the guidelines were published in the Journal of the European Academy of Dermatology and Venerology (JEADV) 1 in autumn 2009. The project (project coordinator: D. Pathirana MD) was started in January 2006, and was supported by the EDF (European Dermatology Forum) in cooperation with the EADV (European Academy of Dermatology and Venerology) and IPC (International Psoriasis Council). A multidisciplinary group of experts, consisting of dermatologists from a broad spectrum of European countries, two dermatologists from the USA, in addition to other relevant medical groups, as well as patient representatives participated in the development of these guidelines. Focus of these guidelines was the systemic induction treatment of psoriasis. In the future, regular updates on guidelines focussing on other important issues on psoriasis are planed: 1) The systemic treatment of psoriasis and arthritic involvement 2) The systemic maintenance treatment of psoriasis 3) The topical treatment of psoriasis vulgaris.

2) German evidence based psoriasis guidelines - update in progress in 2009 / Important results on health care research and guidelines implementation published in 2008/2009

The dEBM (project coordinator: A. Nast MD) is as well coordinating an update of the German psoriasis guidelines, funded by the German Dermatological Society (DDG), which will be finished by the end of 2010. The present version of the German psoriasis guidelines has been accessed more than 50,000 times through its website (www.psoriasis-leitlinie.de) and was translated in several languages. As producing an S3 Guideline involves considerable costs an evaluation study was conducted which was published in 2009 and showed a very good acceptance of the guidelines by German physicians 2. Furthermore changes in the prescription behaviour became visible. In a patient cohort prior to the publication, an unsatisfactory low percentage of patient suffering from moderate to severe psoriasis received a systemic treatment 2. In a subsequent patient cohort after the publication of the German guidelines, we saw an increase in the percentage of patients receiving a systemic treatment 3, 4.

National as well as international guidelines are very important to improve the care of our patients. Through the coordination of both projects it was possible to use synergisms. Nevertheless with the rapid scientific progress in the therapy of this disease those guidelines need continuously to be updated. To meet the challenge the support of everybody involved is needed.

1 European S3-guidelines on the systemic treatment of psoriasis vulgaris.Pathirana D, Ormerod AD, Saiag P et al. J Eur Acad Dermatol Venereol. 2009 Oct;23 Suppl 2:1-70.

2 Low prescription rate for systemic treatments in the management of severe psoriasis vulgaris and psoriatic arthritis in dermatological practices in Berlin and Brandenburg, Germany: results from a patient registry. Nast A, Reytan N, Rosumeck S, Erdmann R, Rzany B. J Eur Acad Dermatol Venereol. 2008 Nov;22(11):1337-42.

3 Nast, A., Erdmann, R., Hofelich, V., Reytan, N., Orawa, H., Sterry, W., Rzany, B. „Do guidelines change the way we treat? Studying prescription behaviour among private practicioners before and after the publication of the German psoriasis guidelines. Arch. Dermatol Res 2009; 301: 553-59

4 Three years after the publication of the German (S3) evidence based Psoriasis Guidelines - Was it worth the effort? Nast A, Rzany B. J Dtsch Dermatol Ges. 2009 Oct 9. [E-pub ahead of print]