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Nanna Nyholm,1 Anne Danø,2 Henrik Schnack,2 Giorgio Lorenzo Colombo3 1LEO Pharma AS, Ballerup, Denmark; 2EY, Frederiksberg, Denmark; 3CEFAT Center of Pharmaceuticals Economics and Medical Technologies Evaluation, Department of Drug Sciences, University of Pavia, Pavia, ItalyCorrespondence: Nanna Nyholm, LEO pharma A/S, Industriparken 55, Ballerup, 2750, Denmark, Tel +45 6178 2096, Email OJYDK@leo-pharma.comObjective: The objective of this study was to optimise the cost-effectiveness of different anti-IL17 treatment sequences used in the treatment of moderate-to-severe plaque psoriasis in Italy and Germany over a five-year time horizon.Methods: We adjusted a previously published treatment sequence model for biologic drugs used in psoriasis treatment to an Italian and German setting, respectively. The model included all anti-IL17 biologics currently available in the treatment of moderate-to-severe plaque psoriasis in the markets of scope (secukinumab, ixekizumab, brodalumab and bimekizumab). Real-world discontinuation rates were used to model switches between the four anti-IL17 biologics included in the study. The treatment costs were based on label dosing recommendations for each drug, including induction and maintenance therapy, and the manufacturer prices of each drug in Italy and Germany, respectively. We used long-term Psoriasis Area and Severity Index 100 (PASI100) measures to inform the model on the efficacy for each treatment. The cost-effectiveness in the analysis was evaluated based on the cost per PASI100-responder.Results: We found that the most cost-effective treatment sequence was achieved by using brodalumab as first-line treatment, bimekizumab as second-line treatment, ixekizumab as third-line treatment and secukinumab as fourth-line treatment in both Italy and Germany, which resulted in a total cost per responder of € 128,200 and € 138,212, respectively, over a five-year period. Several scenario analyses were also conducted and ensured that the results were robust to changes in key input parameters.Conclusion: Our study showed that using brodalumab as a first-line therapy to treat moderate-to-severe psoriasis in both Italy and Germany leads to the most cost-effective treatment sequence, when compared to all possible combinations of anti-IL17s over a five-year time horizon. In addition, we found that treatment discontinuation and switching are important factors when assessing the cost-effectiveness of biologic therapies.Keywords: cost-per-responder, psoriasis vulgaris, treatment sequences, interleukin-17

THE breeding success of a nest-box breeding population of Pied Flycatcher Ficedula hypoleuca in subalpine birch forest in Swedish Lapland was studied over 55 years, with emphasis on the impact of small mustelids and ambient temperature during egg laying, incubation, and brood care. The proportion of nests predated was used as an index for mustelid abundance. Breeding failures were either total, due to breeding interruptions, or partial due to partial hatching failure or nestling death. Overall, mustelid abundance explained the rate of breeding interruptions at any breeding phase, but not when seasons with exceptional (>10%) predation rates were excluded. Variation in the rate of partial failure was unrelated to mustelid abundance. Climatic conditions affected clutch size, rate of breeding interruption, and partial loss of clutches or broods, with particularly pronounced effects during the incubation period. The mustelid abundance and weather conditions also influenced rates of nest-box occupation in subsequent breeding seasons, and the next-box population dynamics covaried with surrounding populations. [ABSTRACT FROM AUTHOR]

The hypothesis that if the variation in a limiting resource is not taken into account in the density measure this may lead to erroneous conclusions about the density-dependence of demographic variables is tested. The result showed that the inclusion of limiting environmental variables into the density measure might drastically influence the conclusion drawn concerning the density-dependence of important demographic variables.

Background: Psoriasis has important physical and psychosocial effects that extend beyond the skin. Understanding the impact of treatment on health‐related quality of life (HRQoL) and patient‐perceived symptom severity in psoriasis is key to clinical decision‐making. Objectives: This post hoc analysis of the PSO‐LONG trial data assessed the impact of long‐term proactive or reactive management with fixed‐dose combination calcipotriene 50 µg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) foam on patient‐reported outcomes (PROs) in patients with psoriasis vulgaris. Methods: Five hundred and twenty‐one patients from the Phase 3, randomized, double‐blind PSO‐LONG trial were included. An initial 4‐week, open‐label phase of fixed‐dose combination Cal/BD foam once daily (QD) was followed by a 52‐week maintenance phase, at the start of which patients were randomized to a proactive management arm (Cal/BD foam twice weekly) or reactive management arm (vehicle foam twice weekly). Patient‐perceived symptom severity and HRQoL were assessed using the Psoriasis Symptom Inventory (PSI), the Dermatology Life Quality Index (DLQI) and the EuroQol‐5D for psoriasis (EQ‐5D‐5L‐PSO). Results: Statistically and clinically significant improvements were observed across all PRO measures. The mean difference (standard deviation) from baseline to Week 4 was −8.97 (6.18) for PSI, −6.02 (5.46) for DLQI and 0.11 (0.15) for EQ‐5D‐5L‐PSO scores. During maintenance, patients receiving reactive management had significantly higher DLQI (15% [p = 0.007]) and PSI (15% [p = 0.0128]) and a numerically lower EQ‐5D‐5L‐PSO mean area under the curve score than patients receiving proactive management (1% [p = 0.0842]). Conclusions: Cal/BD foam significantly improved DLQI, EQ‐5D‐5L‐PSO and PSI scores during the open‐label and maintenance phases. Patients assigned to proactive management had significantly better DLQI and PSI scores and numerically better EQ‐5D‐5L‐PSO versus reactive management. Additionally, baseline flare was associated with worse PROs than the start of a relapse, and patients starting a relapse also had worse PROs than patients in remission. [ABSTRACT FROM AUTHOR]