Adalimumab may reduce depressive symptoms in patients with psoriasis
MedWire News: Adalimumab treatment may reduce depression as well as skin symptoms in patients with psoriasis, thereby improving health-related quality of life (HRQoL), say researchers.
They found that patients with moderate-to-severe psoriasis taking adalimumab experienced an additional 6-point reduction in scores on the Zung Self-rating Depression Scale (ZDS) compared with those taking placebo.
“Although screening for depression symptoms is not commonplace in dermatology practice, appropriate management of psoriasis should include depression screening, with reduction of depression symptoms a treatment goal,” say Alan Menter, from Baylor University Medical Center in Dallas, Texas, USA, and colleagues.
The researchers randomly assigned 96 patients with more than 5% of their body surface affected by psoriasis to receive either adalimumab (40 mg weekly or every other week) or placebo for 12 weeks.
At the start of the study, the 44 adalimumab- and 52 placebo-treated patients had similar ZDS scores, at 42.9 and 45.8, respectively.
By the end of treatment, patients taking adalimumab experienced a significant reduction in depression symptoms, with average ZDS scores decreasing by 6.7 points to 36.2.
The patients taking placebo did not experience a significant reduction, with ZDS scores decreasing by just 1.5 points to 44.2.
The researchers report in the Journal of the American Academy of Dermatology that, at baseline, depressive symptoms were significantly associated with a poorer HRQoL, but not with greater psoriasis severity.
During the 12-week treatment period, however, reductions in depressive symptoms were significantly correlated with both improvements in HRQoL and reductions in psoriasis severity.
The team notes that patients who achieved a 75% reduction in scores on the Psoriasis Area and Severity Index (PASI 75) experienced a significantly greater improvement in depressive symptoms than non-responders, with an average reduction in ZDS scores of 10.6 versus 1.4.
“Although there is no established minimum important difference for ZDS score changes, it is notable that the observed effects of adalimumab versus placebo and of PASI 75 response versus non-response are comparable with half the standard deviation of baseline ZDS scores, a commonly used measure of clinical significance” Menter et al write.
“These results indicate that successful management of psoriasis with adalimumab can substantially reduce depression symptoms for patients with psoriasis.”
However, it remains to be determined whether the effect of adalimumab on depressive symptoms is direct or indirect.
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By Lucy Piper