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Depressive Symptoms, Depression, and the Effect of Biologic Therapy Among Patients With Psoriasis
TAKE-HOME MESSAGE
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The authors of this study used the Psoriasis Longitudinal Assessment and Registry to evaluate the effect of various treatments on depressive symptoms in patients with moderate to severe psoriasis. The incidence rate of depressive symptoms was lower in patients treated with biologic agents compared with the rate in patients treated with phototherapy or conventional systemic agents. In multivariate analyses, the risk of developing depressive symptoms was reduced in patients treated with biologic agents compared with conventional systemic therapy. Phototherapy did not affect the risk of depressive symptoms. Among specific biologic agents, treatment with adalimumab was associated with a reduced risk of developing depressive symptoms. There was a non-significant association between ustekinumab and infliximab treatment and reduced risk of depressive symptoms. Etanercept, however, did not lower the risk of developing depressive symptoms.
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Compared with conventional systemic therapy, biological therapy is associated with a lower risk of developing depressive symptoms in patients with moderate to severe psoriasis.
– Jeffrey Scott, MD
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Patients with psoriasis are at an increased risk for depression. However, the impact of treatment on this risk is unclear.
OBJECTIVE
Evaluate the incidence and impact of treatment on depression among patients with moderate-to-severe psoriasis.
METHODS
We defined a study population within the Psoriasis Longitudinal Assessment and Registry and measured the incidence of depressive symptoms (Hospital Anxiety and Depression Scale-Depression score ≥8) and adverse events (AEs) of depression within cohorts receiving biologics, conventional systemic therapies, or phototherapy. Patients were evaluated at approximately 6-month intervals. Multivariate modeling determined the impact of treatment on risk.
RESULTS
The incidence rates of depressive symptoms were 3.01 per 100 patient-years (PYs) (95% confidence interval [CI], 2.73-3.32), 5.85 per 100 PYs (95% CI, 4.29-7.97), and 5.70 per 100 PYs (95% CI, 4.58-7.10) for biologics, phototherapy, and conventional therapy, respectively. Compared with conventional therapy, biologics reduced the risk for depressive symptoms (hazard ratio, 0.76; 95% CI, 0.59-0.98), whereas phototherapy did not (hazard ratio, 1.05; 95% CI, 0.71-1.54). The incidence rates for AEs of depression were 0.21 per 100 PYs (95% CI, 0.15-0.31) for biologics, 0.55 per 100 PYs (95% CI, 0.21-1.47) for phototherapy, and 0.14 per 100 PYs (95% CI, 0.03-0.55) for conventional therapy; the fact that there were too few events (37 AEs) precluded modeling.
LIMITATIONS
Incomplete capture of depression and confounders in the patients on registry.
CONCLUSION
Compared with conventional therapy, biologics appear to be associated with a lower incidence of depressive symptoms among patients with psoriasis.
Additional Info
Disclosure statements are available on the authors' profiles:
Depressive Symptoms, Depression, and the Effect of Biologic Therapy Among Patients in Psoriasis Longitudinal Assessment and Registry (PSOLAR)
J Am Acad Dermatol 2017 Oct 25;[EPub Ahead of Print], B Strober, M Gooderham, EMGJ de Jong, AB Kimball, RG Langley, N Lakdawala, K Goyal, F Lawson, W Langholff, L Hopkins, S Fakharzadeh, B Srivastava, A MenterFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The most notable finding in this analysis of depression in the PSOLAR study is that biologic agents decrease the risk of developing depressive symptoms as measured by the Hospital Anxiety and Depression Scale—Depression (HADS-D). Moreover, this decrease in depressive symptoms was much more profound than that among patients treated with phototherapy or conventional oral agents. This is not surprising because most biologic agents have been documented to improve depression in psoriasis patients, including brodalumab, which has an unfortunate label warning for suicide in the US (but not in other countries, such as Japan) based on three suicides at one study center. Even the brodalumab data showed that depression, as measured by HADS-D, improved significantly in the course of the phase III clinical trial.1
There are many possible explanations for these findings, but we would like to propose two likely possibilities. The first is that current biologic agents are generally more effective with less burden of treatment (time and effort burden of phototherapy, burden of multiple systemic risks with conventional oral agents). Second is the possibility that biologic agents, by blocking cytokines directly, may have a more profound effect on the patient’s cytokine profile for both psoriasis and depression. Recent studies point to a remarkable similarity between the cytokine profile of psoriasis and that of depression.2 Therefore, it is conceivable that treatment modalities deliberately designed to block these cytokines may also have a more significant effect on depression.
The above PSOLAR data on depression are encouraging, both for patients and providers. However, in science, it is ideal to have two datasets with similar results rather than one. Therefore, more research is needed to confirm the above findings.
References