Do Biologic Agents Lower Depression Risk in Psoriasis?

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Biologic agents reduced the risk for depressive symptoms significantly compared to phototherapy in psoriasis.
Biologic agents reduced the risk for depressive symptoms significantly compared to phototherapy in psoriasis.

Among patients with moderate to severe psoriasis, treatment with biologic agents may reduce the risk for depressive symptoms and possible subsequent suicidality, according to the results of the recent prospective, disease-based Psoriasis Longitudinal Assessment and Registry (PSOLAR) study, published in the Journal of the American Academy of Dermatology.

The goal of the analysis was to evaluate the incidence rates (IRs) and impact of various treatments on depression among patients with moderate to severe psoriasis. The investigators identified a study population within PSOLAR, in whom they measured and compared IRs of depressive symptoms using the Hospital Anxiety and Depression Scale–depression score ≥8 and adverse events associated with depression within cohorts that were receiving biologic agents, conventional systemic therapies, or phototherapy.

All patients were assessed at 6-month intervals, with multivariate modeling to establish the impact of treatment on risk.

A total of 7490 individuals were enrolled in the study. IRs of depressive symptoms were 3.01 per 100 patient-years (PYs) (95% 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 those treated with biologics, phototherapy, and conventional therapy, respectively. Compared with the use of conventional therapy, biologic agents reduced the risk for depressive symptoms significantly (hazard ratio [HR] 0.76; 95% CI, 0.59-0.98; P =.0367), whereas phototherapy did not (HR 1.05; 95% CI, 0.71-1.54; P =.8159).

The IRs for AEs of depression were 0.21 per 100 PYs (95% CI, 0.15-0.31) with biologics, 0.55 per 100 PYs (95% CI, 0.21-1.47) with phototherapy, and 0.14 per 100 PYs (95% CI, 0.03-0.55) with conventional therapy. A total of 37 AEs of depression were reported among the study population, with this low number of AEs thus precluding the use of Cox modeling.

The investigators concluded that additional exploration into the link between biologics and depression among patients with psoriasis is warranted to optimize treatment and more fully comprehend how these agents affect the risk for depression and suicide among these individuals.

Reference

Strober B, Gooderham M, de Jong EMGJ, et al.  Depressive symptoms, depression, and the effect of biologic therapy among patients in Psoriasis Longitudinal Assessment and Registry (PSOLAR) [published online October 25, 2017]. J Am Acad Dermatol. doi:10.1016/j.jaad.2017.08.051

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