patients with psoriasis who discontinued treatment with conventional systemic agents had a reduced risk of depression, anxiety and adjustment disorder after receiving tumor necrosis factor (TNF) inhibitors or ustekinumab, a new study found.
The retrospective cohort study included data from the Quebec Health Administration databases on adults diagnosed with psoriasis between 1997 and 2015.
It included 1,333 psoriasis patients, including 183 treated with TNF inhibitors or ustekinumab, 625 current users of conventional systemic agents (CSAs), and 525 former users of CSAs.
Patients with moderate to severe psoriasis who received tumor necrosis factor inhibitors or ustekinumab after failing CSA treatment had a 52% lower risk of depression, anxiety, and adjustment disorder than those who discontinued CSA treatment (ratio to risk [HR], 0.48; 95% CI, 0.28 – 0.93), the study found. Among those who continued CSA treatment, a nonsignificant reduction in risk of mental health disorders was observed (HR, 0.48; 95% CI, 0.28 – 0.93).
Psoriasis patients are at higher risk of depression, anxiety, and adjustment disorder than the general population. Biologic agents have been more effective than conventional systemic agents, such as methotrexate, in improving psoriasis, trials have shown.
“Randomized controlled trials have found a decreased risk of mental health disorders with TNF inhibitors or ustekinumab compared with CSA and placebo in patients with moderate to severe psoriasis,” said first author Raymond Milan, MSc, of the University McGill. HCPLive®. “However, the risk of mental health disorders was not previously compared between patients who received TNF inhibitors or ustekinumab after CSA failure versus those who continued CSA and those who discontinued CSA treatment for any reason. “.
“One would assume that patients receiving a TNF inhibitor or ustekinumab after CSA has not failed should be at higher risk for mental health outcomes than those continuing to use CSA (presumably no CSA failure) or using CSA (presumably already failed). they don’t need treatment),” he said. he said she. “However, my findings suggested the opposite, which is reassuring for those using TNF inhibitors or ustekinumab, but concerning for those stopping CSA, as some appear to have stopped due to CSA failure.”
The study was consistent with previous randomized controlled trials and observational studies. More research is needed to determine the reason for CSA discontinuation, including whether they may contribute to the improvement or deterioration of mental health.
“Those who discontinue due to CSA failure or mental health issues should be offered TNF inhibitors or ustekinumab treatment if not contraindicated for health reasons,” Milan said. “Furthermore, at the health care system level, improving access to biologics for patients with moderate to severe psoriasis who are at high risk of CSA failure can spare them the burden of going through a failed treatment experience and help improve the results of psoriasis. faster mental health and quality of life outcomes, especially since biological agents are known to be more effective than CSA.”
Study limitations include a lack of data on psoriasis severity, health-related quality of life, or physician advocacy to access biologics. The study also did not evaluate biological agents individually or consider changes in treatment.
“Future studies should include patients receiving a new generation of biological agents such as interleukin 23 and 17 inhibitors,” Milan said. “Future studies should also be multiprovincial to increase the sample size, which will make it possible to study mental health risk through different systemic agents.
Milan also proposed a mediation analysis to determine any direct association between biologic agents and mental health outcomes, or whether the link is indirectly related to quality of life and skin lightening outcomes.
“This type of study will determine the additional risk of having depression, anxiety and adjustment disorder in patients who have versus those who have not improved quality of life and/or skin clearance and help to understand whether these clinical measures are complete, partial, or non-mediators of the association between biological agents and mental health outcomes,” he said.
The study, “Depression, anxiety, and adjustment disorder among psoriasis patients receiving systemic agents: a retrospective cohort study in Quebec, Canada.was posted online at JEADV Clinical Practice.
