A Retrospective Review of Real-World Patterns of Biologic Use in Dermatology Across Metropolitan, Regional and Rural Settings.

BACKGROUND

Biologic therapies have transformed the management of inflammatory dermatologic conditions, including atopic dermatitis, psoriasis, hidradenitis suppurativa, and chronic spontaneous urticaria. However, studies in Australia and abroad highlight reduced uptake in regional areas, underscoring the need to address inequities in access.

METHOD(S): A retrospective audit was performed of adult patients prescribed Pharmaceutical Benefits Scheme (PBS) subsidised biologics for severe atopic dermatitis, chronic plaque psoriasis, hidradenitis suppurativa, or chronic spontaneous urticaria between 1 January 2022 and 31 July 2025. Complete biologic treatment histories were collected for all identified patients, including prescriptions initiated before or continuing after the study period.

RESULTS

A total of 372 patients received PBS-subsidised biologic medications for severe atopic dermatitis (42.7%), chronic spontaneous urticaria (25.8%), chronic plaque psoriasis (22.0%), and hidradenitis suppurativa (9.4%). Approximately 17% of all patients lived in regional/remote areas (Modified Monash Model [MMM] 3-5). Dupilumab (n = 159) and omalizumab (n = 96) were the most commonly prescribed first-line biologics overall. While wait times for appointments and biologic initiation were comparable across rurality classifications (median 72-77 days to first appointment, 226-304 days to first biologic), patients from MMM 3-5 regions faced significantly higher costs per appointment (MMM 3-5 $110, MMM 2 $53 and MMM 1 $36).

CONCLUSIONS

This study highlights regional disparities in biologic therapy access within an Australian tertiary dermatology service. Addressing these inequities is vital to achieving equitable and sustainable dermatologic care.