ArticlePharmacoepidemiology and drug safety2026
Comparing Different As-Treated Approaches: A Methodological Study Using Real-World Data on Psoriasis Treatments.
Article in Pharmacoepidemiology and drug safety, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Comparing Different As-Treated Approaches: A Methodological Study Using Real-World Data on Psoriasis Treatments.Pharmacoepidemiology and drug safety · 2026Article
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4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundAccurate pharmaco-epidemiological assessment of the safety of biological treatments is essential but methodologically challenging.
aimsThis study evaluated how different assumptions regarding treatment switching and treatment episode definitions affect outcome estimates in psoriasis patients, focusing on malignancies and serious infections.
methodsData from Danish national registers (2009-2022) were analyzed for hospitalized psoriasis patients treated with ustekinumab, non-biologics, tumor necrosis factor-α inhibitors, and other interleukin inhibitors excluding ustekinumab. Various as-treated approaches were assessed and compared to the Intention-to-Treat (ITT) approach. The as-treated approaches included: (1) RC-switch, considering switching only between ustekinumab and the comparator in question, (2) Bio-switch, considering switches among all biologics, (3) Multi-switch, analyzing all groups simultaneously, and (4) Hierarchy-switch, analyzing switching by a predefined hierarchy. Hazard ratios (HRs) and 95% confidence intervals (CIs) were analyzed using Cox models. Sensitivity analyses incorporated treatment episodes based on the defined daily dose (DDD) and grace periods.
resultsBroader treatment switching allowances affected outcome estimates. For malignancies, the Bio-switch approach yielded the largest HR changes relative to the ITT. For serious infections, also, Bio-switch produced the largest HR shifts, for example, HR 1.32 (CI 1.09, 1.58) versus ITT HR 1.08 (CI 0.91, 1.29). Sensitivity analyses showed that accounting for episode gaps influenced HRs and widened CIs.
conclusionThe number of events within the exposure group varied by approaches, influencing the HR estimates. The multi-switch approach effectively captured treatment switching and reduced statistical uncertainty, supporting clearer safety conclusions. Tracking each treatment period with gaps reflects real-world practice but may lower statistical power and should be carefully considered in analyses.
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