Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Rapid Communication Dermatology 2006;213:327–330 DOI: 10.1159/000096196 Psoriasis Therapy in Real Life: The Need for Registries Marcus Schmitt-Egenolf Department of Public Health and Clinical Medicine, Dermatology and Venereology, Umeå University, Umeå, Sweden Introduction The selection of the best and safest medicine(s) for an individual patient out of numerous options of today’s pharmacopeia requires substantial knowledge. A registry is a tool to improve this knowledge on a continuous basis. In contrast to randomized clinical trials (RCTs), the pa- tient data in a profession-based registry are based on real- life experience. Ideally registries would include all pso- riasis patients receiving systemic treatment in a given country. However, synthesis of results from the registries across several countries would be the most powerful in- strument. The aim of this article is to stimulate the estab- lishment of registries for systemic psoriasis treatment in several countries and to encourage their cooperation. Even if we ignore the question of the integrity of RCTs [1, 2] for a moment, they still remain by their very struc- ture a limited instrument; RCTs do not provide a repre- sentative model for real-life patients. Accordingly the terms ‘effectiveness’ and ‘efficacy’ have been set apart to help demonstrate the potentially artificial picture we get from RCTs (efficacy) compared to what we see in the ‘real world’(effectiveness). The main objectives of a registry are ( fig. 1 ): – to assess safety and effectiveness of different treat- ments; Key Words Psoriasis registries  Quality assurance, health care  Ethics, medical  Drug therapy  Pharmacogenetics  Clinical trials  Treatment outcome  Tumor necrosis factor, therapeutic use Abstract The introduction of new therapeutic options for the man- agement of psoriasis is a challenge for the dermatology community, and new tools are needed to face this challenge. This article argues for the establishment of profession-based registries to collect solid, long-term data on the safety and effectiveness of different psoriasis treatment regimens. Managed by health care professionals, registries will be most successful if they enroll patients based on indications for treatment rather than on drugs given. This protects the eval- uation process from commercial influences and allows a fair comparison of old- versus new-generation psoriasis treat- ments. In contrast to the patients in a registry who receive care in the natural clinical setting, subjects in randomized clinical trials (RCTs) are selected according to study criteria and may therefore not reflect the experience of patients in clinical practice. It is possible that particular risks and oppor- tunities in the real patient population may therefore go un- detected in RCTs. Copyright © 2006 S. Karger AG, Basel Received: August 7, 2006 Accepted: August 13, 2006 Marcus Schmitt-Egenolf Department of Public Health and Clinical Medicine, Dermatology and Venereology Umeå University, SE–901 85 Umeå (Sweden) Tel. +46 90 785 2875, Fax +46 90 14 3673 E-Mail marcus.schmitt-egenolf@dermven.umu.se © 2006 S. Karger AG, Basel 1018–8665/06/2134–0327$23.50/0 Accessible online at: www.karger.com/drm