Epidemiology and treatment of psoriasis: a Brazilian perspective

Abstract

Psoriasis is a chronic immune-mediated systemic disease that is influenced by genetic and environmental factors, is associated with comorbidities, and has a negative impact on the quality of life of affected individuals. The prevalence of psoriasis varies among different ethnic groups, but this topic has not been studied in Brazil to date. In this review, we evaluate the epidemiology and treatment of psoriasis from a Brazilian perspective. We focused on studies that involved Brazilian subjects. The prevalence of psoriasis in Brazil is estimated to be 2.5%, but no population study has been performed previously. Environmental factors, such as tropical climate, in association with genetic factors, such as miscegenation, may exert a beneficial impact on the course and frequency of psoriasis in Brazil. A number of studies have advanced our understanding of the cardiovascular, ophthalmic, and oral comorbidities that are associated with psoriasis. Concerns about biological therapy, such as endemic leprosy, human T-cell lymphotropic virus (HTLV), and tuberculosis infections, are discussed. The nonavailability of treatment options for psoriasis in the public health system contradicts the Brazilian Society of Dermatology guidelines, stimulating the judicialization of access to medicines in psoriasis care.

Biosimilar Drugs for Psoriasis: Principles, Present, and Near Future

“…The extent or absence of insurance coverage impacts treatment costs, and such factors can create financial barriers that limit or contribute to inequalities in access to biologic therapies. This is particularly true in regions such as Latin America where biologics used to treat moderate-to-severe psoriasis are reimbursed in some (e.g., Argentina, Colombia, Mexico, Venezuela) but not other (e.g., Brazil, Chile) countries [ 38 , 39 ].…”

“…Recent estimates of the annual total and direct healthcare costs of moderate-to-severe psoriasis were $22,713 per patient and $13,731 (mean), respectively, in the USA (adjusted to 2012 US dollars) and €1617–13,343 and €1314–8966 per patient-year, respectively, across France, Germany, Italy, and Spain (adjusted to 2015 euros) [ 131 , 132 ]. Furthermore, healthcare expenditure is substantially greater with biologic drugs versus conventional systemic therapies [ 39 , 133 ]. In a 2014 meeting on economic crisis and healthcare, the Council of the European Union concluded “the prices of many new innovative medicines are very high in relation to the public health expenditure capacities of most Member States, and that this pricing situation could destabilize health systems in Member States already weakened by the financial crisis” [ 134 ].…”

Clinical Goals and Barriers to Effective Psoriasis Care

“…These targets, which have been established to improve patient outcomes in diverse clinical settings within Western countries, may need modification in non-Western countries due to safety concerns in vulnerable populations. For example, Brazil has adopted the European targets with a few modifications due to the high local prevalence of human T-lymphotropic virus (HTLV) and tuberculosis infection burden, which demands screening before initiating treatment with immunosuppressive therapies [ 47 ]. More information is needed to establish the burden of psoriasis within populations of Latin America and the Caribbean in order to gain a stronger understanding of patient perspectives and barriers to care [ 48 ].…”

“…For example, if a target is not met despite the patient being satisfied, insurers might deny payment. In resource-poor countries, such as Brazil, where the government health agencies approve biologics but deny access to the public healthcare system due to economic reasons, physicians would be caught between the treat-to-target guidelines (and patient expectations) and divergent public healthcare policies [ 47 ].…”

Healthcare utilization and medical expenditure of Korean psoriasis patients

“…Previous studies have determined the prevalence of psoriasis in Korea and Brazil and described the demographic and social characteristics of affected individuals. [ 8 , 9 ] A nationwide population-based study in France extended the investigation to include other skin diseases and reported the incidence and prevalence rates of systemic lupus erythematosus. [ 10 ] Other studies from Taiwan [ 11 ] and the United States [ 12 ] analyzed the differences in healthcare service use between patients with and without psoriasis using data from healthcare databases.…”