{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T17:17:23Z","timestamp":1788023843706,"version":"build-2784847793"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T00:00:00Z","timestamp":1674086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sufficient data on access to systemic treatment for patients with psoriasis living in Latin America (LA) including Brazil and Chile are lacking. Understanding the availability and limiting factors of access to treatments can help to improve patient care and decrease long-term healthcare costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>In association with the Global Psoriasis Atlas, this cross-sectional survey study analysed the availability and insurance reimbursement of systemic treatments for adult patients with psoriasis in Brazil and Chile.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multicentre, cross-sectional Global Healthcare Study on Psoriasis was performed in Brazil and Chile in 2020. For each eligible adult patient with psoriasis, doctors and nurses completed a 48-item questionnaire about clinical aspects of psoriasis including the Psoriasis Area Severity Index (PASI), body surface area (BSA) score and the Dermatology Life Quality Index (DLQI), as well as the availability of systemic treatments and insurance reimbursement status. Between-country differences were compared with Wilcoxon rank sum tests for continuous variables, and a \u03c72-test or Fisher\u2019s exact test, where appropriate, for categorical variables. The median and interquartile range (IQR) was calculated for non-normal distributed data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1424 patients with psoriasis from 43 centres [27 centres in Brazil (n = 826) and 16 in Chile (n = 598)], were included with a mean (SD) age of 49.1 (16.3) and 49.2 (15.1) years, respectively. Unstratified analyses revealed that patients with psoriasis in Chile had more severe disease than those in Brazil [PASI 11.6 vs. 8.4 (P &amp;lt; 0.001) and BSA 14.7 vs. 12.0 (P = 0.003), respectively]. For patients with moderate-to-severe psoriasis, defined as PASI and\/or BSA \u2265 10, systemic nonbiologic drugs were available (81.2% in Brazil and 65.3% in Chile, P \u2264 0.001), but only 37.0% of patients in Brazil and 27.3% in Chile received biologics (P = 0.01). Lack of availability and\/or lack of insurance reimbursement for biologic drugs for patients with moderate-to-severe psoriasis was reported for 22.2% (50 of 225) in Brazil and 67.9% (148 of 218) in Chile (P &amp;lt; 0.001). Patients with no access to biologic therapies due to lack of availability\/insurance reimbursement had a median PASI of 9.15 (IQR 3.00\u201314.25) in Brazil and 12.0 (IQR 5.00\u201319.00) in Chile (P = 0.007), as well as a median BSA of 7.0 (IQR 3.00\u201315.00) and 12.0 (IQR 5.00\u201322.50) (P = 0.002), and median DLQI of 11.0 (6.00\u201315.00) and 21.0 (6.50\u201325.00) (P = 0.007), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Chilean patients had significantly more severe psoriasis compared with Brazilian patients in our study. While nonbiologic treatments for moderate-to-severe psoriasis were available in both LA countries, there is a high need for improvement in access to more effective psoriasis treatments including biologics. Our results highlight a significant gap between treatment recommendations in international psoriasis guidelines and real-world situations in Brazil and Chile.<\/jats:p><\/jats:sec>","DOI":"10.1093\/bjd\/ljac128","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T05:10:18Z","timestamp":1674105018000},"page":"533-541","source":"Crossref","is-referenced-by-count":19,"title":["Access to psoriasis treatment in Brazil and Chile: A cross-sectional multicentre Global Healthcare Study on Psoriasis"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9914-1545","authenticated-orcid":false,"given":"Julia-Tatjana","family":"Maul","sequence":"first","affiliation":[{"name":"Department of Dermatology, University Hospital Zurich , Zurich , Switzerland"},{"name":"Faculty of Medicine, University of Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabienne","family":"Fr\u00f6hlich","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University Hospital Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9202-0073","authenticated-orcid":false,"given":"Lara Valeska","family":"Maul","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University Hospital Basel , Basel , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rieka","family":"Stunnenberg","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University Hospital Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Valenzuela","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Chile , Santiago , Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"De La Cruz","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Dermacross , Santiago , Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristi\u00e1n","family":"Vera-Kellet","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Facultad de Medicina, Pontificia Universidad Cat\u00f3lica de Chile , Santiago , Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Armijo","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Dermacross , Santiago , Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wagner G","family":"Cesar","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina do ABC , Proderma , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Universidade do Vale do Rio dos Sinos\/Hospital Moinhos de Vento , Porto Alegre , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes Alexander","family":"Didaskalu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Graf","sequence":"additional","affiliation":[{"name":"Graf Biostatistics , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8257-1816","authenticated-orcid":false,"given":"Alexander","family":"Egeberg","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Bispebjerg Hospital, University of Copenhagen , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jashin J","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Miami, Miller School of Medicine , Miami, FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob P","family":"Thyssen","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Bispebjerg Hospital, University of Copenhagen , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Romiti","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of S\u00e3o Paulo, School of Medicine , S\u00e3o Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E M","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, University of Manchester , Manchester , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,1,19]]},"reference":[{"key":"2023100916151600400_ljac128-B1","doi-asserted-by":"crossref","first-page":"m1590","DOI":"10.1136\/bmj.m1590","article-title":"National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study","volume":"369","author":"Parisi","year":"2020","journal-title":"BMJ"},{"key":"2023100916151600400_ljac128-B2","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1111\/jdv.15177","article-title":"Position statement for the management of comorbidities in psoriasis","volume":"32","author":"Dauden","year":"2018","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2023100916151600400_ljac128-B3","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1016\/j.jid.2018.11.023","article-title":"A transethnic Mendelian randomization study identifies causality of obesity on risk of psoriasis","volume":"139","author":"Ogawa","year":"2019","journal-title":"J Invest Dermatol"},{"key":"2023100916151600400_ljac128-B4","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0140-6736(07)61128-3","article-title":"Pathogenesis and clinical features of psoriasis","volume":"370","author":"Griffiths","year":"2007","journal-title":"Lancet"},{"key":"2023100916151600400_ljac128-B5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1080\/08830185.2018.1539084","article-title":"Psoriasis and cardiovascular disease: the elusive link","volume":"38","author":"Manolis","year":"2019","journal-title":"Int Rev Immunol"},{"key":"2023100916151600400_ljac128-B6","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jaad.2016.07.064","article-title":"Psoriasis and comorbid diseases: epidemiology","volume":"76","author":"Takeshita","year":"2017","journal-title":"J Am Acad Dermatol"},{"key":"2023100916151600400_ljac128-B7","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1111\/j.1468-3083.2010.03705.x","article-title":"Psoriasis: is the impairment to a patient\u2019s life cumulative?","volume":"24","author":"Kimball","year":"2010","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2023100916151600400_ljac128-B8","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1111\/jdv.17348","article-title":"Mapping risk factors for cumulative life course impairment in patients with chronic skin diseases \u2013 a systematic review","volume":"35","author":"von St\u00fclpnagel","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2023100916151600400_ljac128-B9","first-page":"1092","article-title":"German S3-Guideline on the treatment of psoriasis vulgaris, adapted from EuroGuiDerm \u2013 Part 2: Treatment monitoring and specific clinical or comorbid situations","volume":"19","author":"Nast","year":"2021","journal-title":"J Dtsch Dermatol Ges"},{"key":"2023100916151600400_ljac128-B10","first-page":"12","article-title":"Translating the 2019 AAD-NPF Guidelines of Care for the Management of Psoriasis with Biologics to clinical practice","volume":"104","author":"Pithadia","year":"2019","journal-title":"Cutis"},{"key":"2023100916151600400_ljac128-B11","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1016\/j.jaad.2020.02.044","article-title":"Joint American Academy of Dermatology\u2013National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies","volume":"82","author":"Menter","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"2023100916151600400_ljac128-B12","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1111\/jdv.16915","article-title":"EuroGuiDerm Guideline on the systemic treatment of psoriasis vulgaris \u2013 Part 1: treatment and monitoring recommendations","volume":"34","author":"Nast","year":"2020","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2023100916151600400_ljac128-B13","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jaad.2019.08.026","article-title":"Recategorization of psoriasis severity: Delphi consensus from the International Psoriasis Council","volume":"82","author":"Strober","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"2023100916151600400_ljac128-B14","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1016\/S0140-6736(20)32549-6","article-title":"Psoriasis","volume":"397","author":"Griffiths","year":"2021","journal-title":"Lancet"},{"key":"2023100916151600400_ljac128-B15","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1038\/jid.2012.339","article-title":"Global epidemiology of psoriasis: a systematic review of incidence and prevalence","volume":"133","author":"Parisi","year":"2013","journal-title":"J Invest Dermatol"},{"key":"2023100916151600400_ljac128-B16","doi-asserted-by":"crossref","first-page":"e028116","DOI":"10.1136\/bmjopen-2018-028116","article-title":"Prevalence and characteristics of psoriasis in Denmark: findings from the Danish skin cohort","volume":"9","author":"Egeberg","year":"2019","journal-title":"BMJ Open"},{"key":"2023100916151600400_ljac128-B17","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1111\/ced.14713","article-title":"The incidence of psoriasis in Chile: an analysis of the National Waiting List Repository","volume":"46","author":"Lecaros","year":"2021","journal-title":"Clin Exp Dermatol"},{"key":"2023100916151600400_ljac128-B18","doi-asserted-by":"crossref","first-page":"e167\u20138","DOI":"10.1111\/ijd.13604","article-title":"Prevalence of psoriasis in Brazil \u2013 a geographical survey","volume":"56","author":"Romiti","year":"2017","journal-title":"Int J Dermatol"},{"key":"2023100916151600400_ljac128-B19","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1111\/jdv.14393","article-title":"Psoriasis in Latin America and the Caribbean: a systematic review","volume":"31","author":"Hern\u00e1ndez-V\u00e1squez","year":"2017","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2023100916151600400_ljac128-B20","doi-asserted-by":"crossref","first-page":"445","DOI":"10.3899\/jrheum.111246","article-title":"Global partnering opportunities and challenges of psoriasis and psoriatic arthritis in Latin America: a report from the GRAPPA 2010 annual meeting","volume":"39","author":"Espinoza","year":"2012","journal-title":"J Rheumatol"},{"key":"2023100916151600400_ljac128-B21","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1590\/abd1806-4841.20142874","article-title":"Comorbidities and cardiovascular risk factors in patients with psoriasis","volume":"89","author":"Baeta","year":"2014","journal-title":"An Bras Dermatol"},{"key":"2023100916151600400_ljac128-B22","doi-asserted-by":"crossref","first-page":"13030","DOI":"10.5070\/D3229032495","article-title":"Psoriasis in Latin America","volume":"22","author":"Chouela","year":"2016","journal-title":"Dermatol Online J"},{"key":"2023100916151600400_ljac128-B23","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.abd.2021.03.007","article-title":"Brazilian Consensus on Psoriasis 2020 and treatment algorithm of the Brazilian Society of Dermatology","volume":"96","author":"Romiti","year":"2021","journal-title":"An Bras Dermatol"},{"issue":"Suppl. 1","key":"2023100916151600400_ljac128-B24","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/ijd.14471","article-title":"Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis SOLAPSO \u2013 Sociedad Latinoamericana de Psoriasis (Latin American Psoriasis Society)","volume":"58","author":"Kogan","year":"2019","journal-title":"Int J Dermatol"},{"key":"2023100916151600400_ljac128-B25","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/jdv.12106","article-title":"Psoriasis Area Severity Index (PASI) and the Dermatology Life Quality Index (DLQI): the correlation between disease severity and psychological burden in patients treated with biological therapies","volume":"28","author":"Mattei","year":"2014","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2023100916151600400_ljac128-B26","first-page":"S14","article-title":"The skin in psoriasis: assessment and challenges","volume":"33","author":"Oji","year":"2015","journal-title":"Clin Exp Rheumatol"},{"key":"2023100916151600400_ljac128-B27","author":"R Core Team"},{"key":"2023100916151600400_ljac128-B28","author":"Yoshida"},{"key":"2023100916151600400_ljac128-B29","author":"Salud"},{"key":"2023100916151600400_ljac128-B30","author":"Sa\u00fade"},{"key":"2023100916151600400_ljac128-B31","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1590\/S0034-8910.2014048005109","article-title":"Sanches do Nascimento Silveira M, Alves de Camargo I et al. Biological drugs for the treatment of psoriasis in a public health system","volume":"48","author":"Cruz Lopes","year":"2014","journal-title":"Rev Saude Publica"},{"key":"2023100916151600400_ljac128-B32","volume-title":"The Pharma Legal Handbook: Brazil","author":"Frizzo","year":"2020"},{"key":"2023100916151600400_ljac128-B33","volume-title":"The Pharma Legal Handbook: Chile","author":"Carey","year":"2019"},{"key":"2023100916151600400_ljac128-B34","doi-asserted-by":"crossref","first-page":"231","DOI":"10.21115\/JBES.v12.n3.p231-40","article-title":"Cost-effectiveness of moderate-to-severe psoriasis biologic treatments in Brazilian private healthcare system: cost-per-responder results derived from a network metanalysis","volume":"12","author":"Carvalho","year":"2020","journal-title":"J Brasileiro de Economia da Sa\u00fade"},{"key":"2023100916151600400_ljac128-B35","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1080\/09546634.2018.1466023","article-title":"Assessment of psoriasis severity in Brazilian patients with chronic plaque psoriasis attending outpatient clinics: a multicenter, population-based cross-sectional study (APPISOT)","volume":"29","author":"Romiti","year":"2018","journal-title":"J Dermatolog Treat"},{"key":"2023100916151600400_ljac128-B36","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1111\/bjd.20387","article-title":"Association of sex and systemic therapy treatment outcomes in psoriasis: a two-country, multicentre, prospective, noninterventional registry study","volume":"185","author":"Maul","year":"2021","journal-title":"Br J Dermatol"},{"key":"2023100916151600400_ljac128-B37","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/jdv.15324","article-title":"Gender and age significantly determine patient needs and treatment goals in psoriasis \u2013 a lesson for practice","volume":"33","author":"Maul","year":"2019","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2023100916151600400_ljac128-B38","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1159\/000452740","article-title":"Efficacy and survival of systemic psoriasis treatments: an analysis of the Swiss registry SDNTT","volume":"232","author":"Maul","year":"2016","journal-title":"Dermatology"},{"key":"2023100916151600400_ljac128-B39","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/j.1365-2133.2012.10835.x","article-title":"The British Association of Dermatologists\u2019 Biologic Interventions Register (BADBIR): design, methodology and objectives","volume":"166","author":"Burden","year":"2012","journal-title":"Br J Dermatol"},{"key":"2023100916151600400_ljac128-B40","first-page":"48","article-title":"German psoriasis registry PsoBest: objectives, methodology and baseline data","volume":"12","author":"Augustin","year":"2014","journal-title":"J Dtsch Dermatol Ges"}],"container-title":["British Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjd\/advance-article-pdf\/doi\/10.1093\/bjd\/ljac128\/49157572\/ljac128.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjd\/article-pdf\/188\/4\/533\/51961084\/ljac128.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjd\/article-pdf\/188\/4\/533\/51961084\/ljac128.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T00:38:01Z","timestamp":1701736681000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjd\/article\/188\/4\/533\/6991864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,19]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,1,19]]},"published-print":{"date-parts":[[2023,3,30]]}},"URL":"https:\/\/doi.org\/10.1093\/bjd\/ljac128","relation":{},"ISSN":["0007-0963","1365-2133"],"issn-type":[{"value":"0007-0963","type":"print"},{"value":"1365-2133","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,4,1]]},"published":{"date-parts":[[2023,1,19]]}}}