The BIOBADADERM registry prospectively collects demographic data, clinical management data, and data on adverse events from 14 Spanish hospitals under conditions of daily clinical practice. Therefore, it is extremely useful for determining the therapeutic management of moderate to severe psoriasis in Spain.

In this article from the BIOBADADERM study group,1 the authors describe the clinical characteristics of patients who receive biologic drugs as first-line therapy in daily clinical practice. These are the first published data of this type, since, according to the summary of product characteristics, biologic drugs are usually prescribed after classic systemic treatments. Patients who receive biologics as first-line therapy more often have arterial hypertension, diabetes mellitus, chronic liver disease, hepatitis C, and HIV infection. Therefore, it seems that the main reason classic systemic options are ruled out as first-line therapy is to avoid associated interactions and adverse effects.

In contrast, there are no differences in clinical characteristics, medical management, or adverse effects between patients who receive biologics as first- or second-line therapy.

This study opens the debate on the advantages and disadvantages of biologic treatment as first-line systemic treatment before conventional therapy.