Depressive symptoms, depression, and the effect of biologic therapy among patients in Psoriasis Longitudinal Assessment and Registry (PSOLAR)

Publication date: Available online 6 November 2017
Source:Journal of the American Academy of Dermatology
Author(s): Bruce Strober, Melinda Gooderham, Elke M.G.J. de Jong, Alexa B. Kimball, Richard G. Langley, Nikita Lakdawala, Kavitha Goyal, Fabio Lawson, Wayne Langholff, Lori Hopkins, Steve Fakharzadeh, Bhaskar Srivastava, Alan Menter
BackgroundPatients with psoriasis are at an increased risk for depression. However, the impact of treatment on this risk is unclear.ObjectiveEvaluate the incidence and impact of treatment on depression among patients with moderate-to-severe psoriasis.MethodsWe 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.ResultsThe 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.LimitationsIncomplete capture of depression and confounders in the patients on registry.ConclusionCompared with conventional therapy, biologics appear to be associated with a lower incidence of depressive symptoms among patients with psoriasis.