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Schmitt-Egenolf, MarcusORCID iD iconorcid.org/0000-0002-3858-8474
Publications (10 of 48) Show all publications
Hjalte, F., Steen Carlsson, K. & Schmitt-Egenolf, M. (2018). Sustained Psoriasis Area and Severity Index, DermatologyLife Quality Index and EuroQol-5D response of biologicaltreatment in psoriasis: 10 years of real-world data in theSwedish National Psoriasis Register. British Journal of Dermatology, 178(1), 245-252
Open this publication in new window or tab >>Sustained Psoriasis Area and Severity Index, DermatologyLife Quality Index and EuroQol-5D response of biologicaltreatment in psoriasis: 10 years of real-world data in theSwedish National Psoriasis Register
2018 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 178, no 1, p. 245-252Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Few studies have analysed the long-term effects of biological treatment in psoriasis. PsoReg, the Swedish national register for systemic psoriasis treatment, started in 2006 and includes now ten years of real-world data on effectiveness of biological treatment.

OBJECTIVE: To analyse long-term real-world outcome data on biological-naïve patients with moderate to severe psoriasis after switching to biological treatment.

METHODS: Observational study including biological-naïve patients with at least one registration of outcome before switching to biological treatment while included in PsoReg and at least one follow-up visit. PASI, DLQI and EQ-5D values were analysed at 3-5 months, 6-11 months, and at least once 1 year and above, up to 9 years after switch to biological treatment.

RESULTS: 583 patients fulfilled the inclusion criteria. Of these, 399/395/373 patients had observed outcome data beyond one year on PASI/DLQI/EQ-5D, respectively, and 164/168/152 were observed in at least three time periods after switch. Significant (p<0.01) improvement in PASI, DLQI and EQ-5D was observed 3-5 months after switch and sustained under the whole observation period. Mean PASI/DLQI/EQ-5D changed from 13.5 (SD 9.1)/9.0 (SD 8.1)/0.737 (SD 0.222), respectively, before switch, to 4.0 (SD 3.5)/3.7 (SD 4.7)/0.792 (SD 0.208), respectively, 1-5 years after switch.

CONCLUSION: Biological treatment, as used in clinical practice, show a stable long term effectiveness in all measured dimensions: PASI, DLQI and EQ-5D.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-137285 (URN)10.1111/bjd.15757 (DOI)000423061900077 ()28644904 (PubMedID)
Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2018-06-09Bibliographically approved
Bröms, G., Kieler, H., Ekbom, A., Hellgren, K., Gissler, M., Lahesmaa-Korpinen, A.-M., . . . Granath, F. (2018). Tnf inhibitor treatment during pregnancy and risk of preterm birth. Paper presented at 34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Prague Congress Centre, Prague, Czech Republic, August 22–26, 2018. Pharmacoepidemiology and Drug Safety, 27, 30-31, Article ID 60.
Open this publication in new window or tab >>Tnf inhibitor treatment during pregnancy and risk of preterm birth
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2018 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 27, p. 30-31, article id 60Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:umu:diva-152227 (URN)10.1002/pds.4629 (DOI)000441893800060 ()
Conference
34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Prague Congress Centre, Prague, Czech Republic, August 22–26, 2018
Note

Supplement 2

Available from: 2018-10-25 Created: 2018-10-25 Last updated: 2018-10-25Bibliographically approved
Schmitt-Egenolf, M. (2018). What can we learn from 'dropouts' in clinical trials?. British Journal of Dermatology, 178(2), 318-319
Open this publication in new window or tab >>What can we learn from 'dropouts' in clinical trials?
2018 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 178, no 2, p. 318-319Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-145380 (URN)10.1111/bjd.16220 (DOI)000425009400050 ()29441540 (PubMedID)
Available from: 2018-03-09 Created: 2018-03-09 Last updated: 2018-06-09Bibliographically approved
Geale, K., Henriksson, M. & Schmitt-Egenolf, M. (2017). How is disease severity associated with quality of life in psoriasis patients?: Evidence from a longitudinal population-based study in Sweden. Health and Quality of Life Outcomes, 15(1), Article ID 151.
Open this publication in new window or tab >>How is disease severity associated with quality of life in psoriasis patients?: Evidence from a longitudinal population-based study in Sweden
2017 (English)In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 15, no 1, article id 151Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Assessing the impact of disease severity on generic quality of life (QOL) is a critical step in outcomes research and in the development of decision-analytic models structured around health states defined by clinical measures. While data from routine clinical practice found in healthcare registers are increasingly used for research, more attention should be paid to understanding the relationship between clinical measures of disease severity and QOL. The purpose of this work was therefore to investigate this relationship in psoriasis using a population-based dataset.

METHODS: Severity was measured by the Psoriasis Area and Severity Index (PASI), which combines severity of erythema, induration, and desquamation into a single value ranging from 0 to 72. The generic EQ-5D-3L utility instrument, under the UK tariff, was used to measure QOL. The association between PASI and EQ-5D-3L was estimated using a population-based dataset of 2674 patients with moderate to severe psoriasis enrolled over ten years in the Swedish psoriasis register (PsoReg). Given the repeated measurement of patients in the register data, a longitudinal fixed-effects model was employed to control for unobserved patient-level heterogeneity.

RESULTS: Marginal changes in PASI are associated with a non-linear response in EQ-5D-3L: Moving from PASI 10 to 9 (1 to 0) is associated with an increase of 0.0135 (0.0174) in EQ-5D-3L. Furthermore, unobserved patient-level heterogeneity appears to be an important source of confounding when estimating the relationship between QOL and PASI.

CONCLUSIONS: Using register data to estimate the impact of disease severity on QOL while controlling for unobserved patient-level heterogeneity shows that PASI appears to have a larger impact on QOL than previously estimated. Routine collection of generic QOL data in registers should be encouraged to enable similar applications in other disease areas.

Keywords
Quality of life, EQ-5D; Disease severity, Population-based data, Register data, Psoriasis
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Dermatology and Venerology
Identifiers
urn:nbn:se:umu:diva-138071 (URN)10.1186/s12955-017-0721-x (DOI)000406615700001 ()28754116 (PubMedID)
Available from: 2017-08-06 Created: 2017-08-06 Last updated: 2018-06-09Bibliographically approved
Norlin, J. M., Calara, P. S., Persson, U. & Schmitt-Egenolf, M. (2017). Real-world outcomes in 2,646 psoriasis patients: one in five has PASI ≥ 10 and/or DLQI ≥ 10 under ongoing systemic therapy. Journal of dermatological treatment (Print), 28(6), 500-504
Open this publication in new window or tab >>Real-world outcomes in 2,646 psoriasis patients: one in five has PASI ≥ 10 and/or DLQI ≥ 10 under ongoing systemic therapy
2017 (English)In: Journal of dermatological treatment (Print), ISSN 0954-6634, E-ISSN 1471-1753, Vol. 28, no 6, p. 500-504Article in journal (Refereed) Published
Abstract [en]

Background Although biologics introduced a new era in psoriasis care when available a decade ago, it is unclear to what extent the available systemic treatments treat patients adequately. Objective To analyse the clinical severity and quality of life of the psoriasis population in Sweden treated with systemics. Methods Data included 2,646 patients from the Swedish Registry for Systemic Treatment of Psoriasis. Average Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and EQ-5D were reported. A subgroup of persisting moderate-to-severe psoriasis as defined by PASI≥10 and/or DLQI≥10 after >12 weeks treatment was analysed. Results Mean (SD) PASI, DLQI, and EQ-5D were 4.12 (4.57), 4.11 (5.24) and 0.79 (0.22). Eighteen percent had persisting moderate-to-severe psoriasis (n = 472). These patients were younger, had higher BMI, had psoriasis arthritis and were smoking to a larger extent (p < 0.01) compared to lower-severity patients (n = 2174). Mean (SD) EQ-5D was also considerably lower 0.63 (0.29) vs. 0.82 (0.19) (p < 0.01). Conclusion Almost one in every five patients had persisting moderate-to-severe psoriasis, despite ongoing systemic treatment. Both comorbidities and life style factors were associated with persisting moderate-to-severe psoriasis. The considerably lower generic quality of life in these patients demonstrates an unmet need. Subsequently, improved access to biologics and continuous drug development is needed in psoriasis.

Keywords
Psoriasis, PASI, DLQI, EQ-5D
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-131080 (URN)10.1080/09546634.2017.1289147 (DOI)000412796100006 ()28132580 (PubMedID)
Available from: 2017-02-06 Created: 2017-02-06 Last updated: 2018-06-09Bibliographically approved
Calara, P. S., Althin, R., Carlsson, K. S. & Schmitt-Egenolf, M. (2017). Regional Differences in the Prescription of Biologics for Psoriasis in Sweden: a Register-Based Study of 4168 Patients. BioDrugs, 31(1), 75-82
Open this publication in new window or tab >>Regional Differences in the Prescription of Biologics for Psoriasis in Sweden: a Register-Based Study of 4168 Patients
2017 (English)In: BioDrugs, ISSN 1173-8804, E-ISSN 1179-190X, Vol. 31, no 1, p. 75-82Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Observational studies suggest an inequitable prescription of biologics in psoriasis care, which may be attributed to geographical differences in treatment access. Sweden regularly ranks high in international comparisons of equitable healthcare, and is, in connection with established national registries, an ideal country to investigate potential inequitable access.

OBJECTIVE: The aim was to determine whether the opportunity for patients to receive biologics depends on where they receive care.

METHODS: Biologic-naïve patients enrolled in the Swedish National Register for Systemic Treatment of Psoriasis (PsoReg) from 2008 to 2015 (n = 4168) were included. The association between the likelihood of initiating a biologic and the region where patients received care was analyzed. The strength of the association was adjusted for patient and clinical characteristics, as well as disease severity using logistic regression analysis. The proportion of patients that switched to a biologic (switch rate) and the probability of switch to a biologic was calculated in 2-year periods.

RESULTS: The national switch rate increased marginally over time from 9.7 to 11.0%, though the uptake varied across regions. Adjusted odds ratios for at least one region were significantly different from the reference region in every 2-year period. During the latest period (2014-2015), the average patient in the lowest prescribing region was nearly 2.5 times less likely to switch as a similar patient in the highest prescribing region.

CONCLUSIONS: Geographical differences in biologics prescription persist after adjusting for patient characteristics and disease severity. The Swedish example calls for further improvements in delivering equitable psoriasis care.

Keywords
Psoriasis, Epidemiology, discrimination, postcode
National Category
Dermatology and Venereal Diseases
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-130437 (URN)10.1007/s40259-016-0209-y (DOI)000393693000005 ()28097638 (PubMedID)
Available from: 2017-01-20 Created: 2017-01-20 Last updated: 2018-06-09Bibliographically approved
Hägg, D., Sundström, A., Eriksson, M. & Schmitt-Egenolf, M. (2017). Severity of psoriasis differs between men and women: a registry based study of the clinical outcome measure Psoriasis Area and Severity Index (PASI) in 5438 patients. American Journal of Clinical Dermatology, 18, 583-590
Open this publication in new window or tab >>Severity of psoriasis differs between men and women: a registry based study of the clinical outcome measure Psoriasis Area and Severity Index (PASI) in 5438 patients
2017 (English)In: American Journal of Clinical Dermatology, ISSN 1175-0561, E-ISSN 1179-1888, Vol. 18, p. 583-590Article in journal (Refereed) Published
Abstract [en]

Background: Psoriasis is a common skin disease and moderate to severe psoriasis is associated with a dose-dependent risk for metabolic and cardiovascular morbidity. It has previously been speculated that women have less severe psoriasis, as men are overrepresented in psoriasis registers and consume more care.

Objective: The objective of this study was to investigate, for the first time, the sex differences in the severity of psoriasis using the gold standard of severity measurement, the Psoriasis Area and Severity Index (PASI), and the distinct elements of the PASI score.

Design, Setting and Participants: This was a cross-sectional study based on the national registry for systemic treatment of psoriasis in Sweden (PsoReg), with 5438 patients experiencing moderate to severe psoriasis. Differences in the PASI score and its elements at enrolment were tested by multivariable ordinal logistic regressions.

Main Outcome Measures: The different components of the PASI score were used to analyze the assessment of disease severity. For each body area (head, arms, trunk, and legs), the score of the plaque characteristics and degree of skin involvement were used as outcomes.

Results: Women had statistically significantly lower median PASI scores (5.4) than men (7.3) [p < 0.001], which was consistent across all ages. The difference remained statistically significant in a multivariable linear regression. The itemized PASI analyses from the Mann–Whitney–Wilcoxon tests and the adjusted ordinal logistic regressions confirmed that women had significantly lower scores than men in all areas of the body, except for the head. No differences in the use of medications prior to enrolment could be found that may cause this difference between the sexes.

Conclusions: As the PsoReg contains the detailed disease measurement PASI, which was traditionally used for selected participants in clinical studies only, a nationwide unselected population could be investigated. The fact that women have less severe psoriasis can explain the dominance of males in the systemic treatment of psoriasis. These findings motivate a gender perspective in the management of psoriasis and in the prevention and management of its comorbidities.

National Category
Dermatology and Venereal Diseases
Research subject
Dermatology and Venerology
Identifiers
urn:nbn:se:umu:diva-113900 (URN)10.1007/s40257-017-0274-0 (DOI)000405548600011 ()
Available from: 2016-01-05 Created: 2016-01-05 Last updated: 2018-06-07Bibliographically approved
Gaele, K., Henriksson, M. & Schmitt-Egenolf, M. (2016). Evaluating equality in psoriasis healthcare: a cohort study of the impact of age on prescription biologics. British Journal of Dermatology, 174(3), 579-587
Open this publication in new window or tab >>Evaluating equality in psoriasis healthcare: a cohort study of the impact of age on prescription biologics
2016 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 174, no 3, p. 579-587Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Inequality in healthcare has been identified in many contexts. To the best of our knowledge, this is the first study investigating age inequity in the form of prescription patterns of biologics in psoriasis care.

OBJECTIVE:

To determine whether psoriasis patients have equitable opportunities to receive biologic medications as they age. If patients do not receive equitable treatment, a subsequent objective is to determine the magnitude of the disparity.

METHODS:

A cohort of biologic-naïve psoriasis patients were analysed using Cox proportional hazard models to measure the impact of each additional year of life on the likelihood of initiating biologic treatment, after controlling for sex, body mass index, comorbidities, disease activity, and education level. A supporting analysis used a non-parametric graphical method to study the proportion of patients initiating biologic treatment as age increases, after controlling for the same covariates.

RESULTS:

The Cox proportional hazards model results in a hazard ratio of a one year increase in age of 0.963 to 0.969 depending on calendar year stratification, which implies that an increase in age of 30 years corresponds to a reduced likelihood of initiating biologic treatment by 61.3-67.6%. The estimated proportion of patients initiating biologic medication is always decreasing as age increases, at a statistically significant level.

CONCLUSIONS:

Psoriasis patients have fewer opportunities to access biologic medications as they age. This result was shown to be applicable at all stages in a patient's life course and was not only restricted to the elderly, although it implies greater disparities as the age difference between patients increases. These results show that inequity in access to biologic treatments due to age is prevalent in clinical practice today. Further research is needed to investigate the extent to which this result is influenced by patient preferences. 

Keywords
psoriasis
National Category
Dermatology and Venereal Diseases
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-112179 (URN)10.1111/bjd.14331 (DOI)000372805100027 ()26616003 (PubMedID)
Available from: 2015-12-03 Created: 2015-12-03 Last updated: 2018-06-07Bibliographically approved
Calara, P. S., Norlin, J. M., Althin, R., Steen Carlsson, K. & Schmitt-Egenolf, M. (2016). Healthcare Provider Type and Switch to Biologics in Psoriasis: Evidence from Real-World Practice. BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy, 30(2), 145-151
Open this publication in new window or tab >>Healthcare Provider Type and Switch to Biologics in Psoriasis: Evidence from Real-World Practice
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2016 (English)In: BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy, ISSN 1173-8804, Vol. 30, no 2, p. 145-151Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Previous research indicates an uneven uptake of biologics in patients with moderate-to-severe psoriasis in Sweden. Therefore, it is essential to scrutinise variations in treatment patterns.

OBJECTIVE: The aim of this study was to evaluate the extent to which the uptake of biologics for psoriasis differs between types of healthcare provider.

METHODS: Three types of provider were identified within 52 units participating in the Swedish National Registry for Systemic Psoriasis Treatment (PsoReg): university hospitals, non-university hospitals and individual practices. Biologics-naïve patients (n = 3165) were included in analyses to investigate the probability of switch to biologics. The numbers of patients fulfilling the criteria for moderate-to-severe psoriasis [Psoriasis Area and Severity Index (PASI) ≥10 and Dermatology Life Quality Index (DLQI) ≥10] among patients who switched to biologics and patients who did not switch were reported. A logistic regression model was used to calculate how healthcare provider type influenced the probability of switch to biologics whilst adjusting for patient characteristics and disease severity.

RESULTS: During registration, 16 % of patients switched to biologics while 84 % remained on conventional systemic treatment. In 7 % of patients, the criteria PASI ≥10 and DLQI ≥10 was fulfilled at their last visit without switching to biologics, whereas in 10 % of patients the criteria was not fulfilled prior to switch. After controlling for patient characteristics and disease severity, small or no difference in the probability of switch was observed between provider types.

CONCLUSIONS: Disease severity does not explain the decision to switch or not to switch to biologics for a disproportionate number of patients. There seems to be an uneven uptake of biologics in Swedish clinical practice, but the type of healthcare provider cannot explain this variation. More research is needed on what factors influence the prescription of biologics.

National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-117105 (URN)10.1007/s40259-016-0163-8 (DOI)000376501000008 ()26883786 (PubMedID)
External cooperation:
Available from: 2016-02-22 Created: 2016-02-22 Last updated: 2018-06-07Bibliographically approved
Kapferer-Seebacher, I., Pepin, M., Werner, R., Aitman, T. J., Nordgren, A., Stoiber, H., . . . Zschocke, J. (2016). Periodontal Ehlers-Danlos Syndrome Is Caused by Mutations in C1R and C1S, which Encode Subcomponents C1r and C1s of Complement. American Journal of Human Genetics, 99(5), 1005-1014
Open this publication in new window or tab >>Periodontal Ehlers-Danlos Syndrome Is Caused by Mutations in C1R and C1S, which Encode Subcomponents C1r and C1s of Complement
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2016 (English)In: American Journal of Human Genetics, ISSN 0002-9297, E-ISSN 1537-6605, Vol. 99, no 5, p. 1005-1014Article in journal (Refereed) Published
Abstract [en]

Periodontal Ehlers-Danlos syndrome (pEDS) is an autosomal-dominant disorder characterized by early-onset periodontitis leading to premature loss of teeth, joint hypermobility, and mild skin findings. A locus was mapped to an approximately 5.8 Mb region at 12p13.1 but no candidate gene was identified. In an international consortium we recruited 19 independent families comprising 107 individuals with pEDS to identify the locus, characterize the clinical details in those with defined genetic causes, and try to understand the physiological basis of the condition. In 17 of these families, we identified heterozygous missense or in-frame insertion/deletion mutations in C1R (15 families) or C1S (2 families), contiguous genes in the mapped locus that encode subunits C1r and C1s of the first component of the classical complement pathway. These two proteins form a heterotetramer that then combines with six C1q subunits. Pathogenic variants involve the subunit interfaces or inter-domain hinges of C1r and C1s and are associated with intracellular retention and mild endoplasmic reticulum enlargement. Clinical features of affected individuals in these families include rapidly progressing periodontitis with onset in the teens or childhood, a previously unrecognized lack of attached gingiva, pretibial hyperpigmentation, skin and vascular fragility, easy bruising, and variable musculoskeletal symptoms. Our findings open a connection between the inflammatory classical complement pathway and connective tissue homeostasis.

Place, publisher, year, edition, pages
Cell Press, 2016
National Category
Medical Genetics
Identifiers
urn:nbn:se:umu:diva-126983 (URN)10.1016/j.ajhg.2016.08.019 (DOI)000387529600001 ()27745832 (PubMedID)
Available from: 2016-10-25 Created: 2016-10-25 Last updated: 2018-06-09Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-3858-8474

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