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

作者：Strober Bruce^*; Gooderham Melinda; de Jong Elke M G J; Kimball Alexa B; Langley Richard G; Lakdawala Nikita; Goyal Kavitha; Lawson Fabio; Langholff Wayne; Hopkins Lori; Fakharzadeh Steve; Srivastava Bhaskar; Menter Alan

来源：Journal of the American Academy of Dermatology, 2018, 78(1): 70-80.

DOI：10.1016/j.jaad.2017.08.051

• biologic therapy
• depression
• phototherapy
• PSOLAR
• psoriasis
• systemic therapy

Background: 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.

• 出版日期2018-1