The effect of adalimumab on reducing depression symptoms in patients with moderate to severe psoriasis: A randomized clinical trial

• Published in: Journal of the American Academy of Dermatology Vol. 62; no. 5; pp. 812 - 818
• Main Authors: Menter, Alan, MD, Augustin, Matthias, MD, Signorovitch, James, PhD, Yu, Andrew P., PhD, Wu, Eric Q., PhD, Gupta, Shiraz R., PharmD, Bao, Yanjun, PhD, Mulani, Parvez, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2010; Elsevier
• Subjects: Adalimumab; Adult; Adult and adolescent clinical studies; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antirheumatic Agents - therapeutic use; Biological and medical sciences; Depression; Depression - drug therapy; Dermatology; Double-Blind Method; Female; Humans; Male; Medical sciences; Middle Aged; Mood disorders; psoriasis; Psoriasis - complications; Psoriasis - drug therapy; Psoriasis - psychology; Psoriasis. Parapsoriasis. Lichen; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality of Life; tumor necrosis factor; DLQI; PCS; Physical Component Summary; PASI; 75% or greater reduction in Psoriasis Area and Severity Index score; PASI 75; ZDS; health-related quality of life; Psoriasis Area and Severity Index; TNF; adalimumab; ET; early termination; Mental Component Summary; tumor necrosis factor; psoriasis; Dermatology Life Quality Index; Zung Self-rating Depression Scale; HRQOL; depression; MCS; Mood disorder; Human; Immunomodulator; Symptomatology; Skin disease; Psoriasis; Dermatology; Antipsoriatic agent; Clinical trial; Depression; Adalimumab
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2009.07.022

Background Psoriasis is associated with health-related quality-of-life impairment and depression. Objective We sought to determine the effect of adalimumab on depression symptoms in patients with psoriasis. Methods Patients with moderate to severe psoriasis in a randomized, placebo-controlled, double-blind clinical trial were assessed for depression symptoms at baseline and week 12 or early termination (ET) using the Zung Self-rating Depression Scale (ZDS). The effects of adalimumab (40 mg every other week) versus placebo on ZDS score at week 12/ET were assessed using analysis of covariance. Relationships between ZDS and the Psoriasis Area and Severity Index (PASI), the Dermatology Life Quality Index, and the Short Form 36 Health Survey were assessed using Pearson correlations. Changes in ZDS score were compared for patients with and without a 75% or greater reduction in baseline PASI score. Results Compared with the placebo group (n = 52), the adalimumab group (n = 44) experienced an additional 6-point reduction in ZDS score (95% confidence interval: 2.5-9.5; P < .001) by week 12/ET. Depression improvement was correlated with improvement in PASI ( r  = 0.5; P < .0001) and Dermatology Life Quality Index ( r  = 0.5; P < .0001). Greater ZDS score improvement was observed at week 12/ET in responders with a 75% or greater reduction in baseline PASI score than in nonresponders (10.6 [SD = 9.4] vs 1.4 [SD = 9.6]; P < .001). Limitations This analysis cannot distinguish whether adalimumab has a direct or indirect effect on depression. Conclusions Adalimumab treatment reduced psoriasis symptoms, reduced depression symptoms, and improved health-related quality of life in patients with moderate to severe psoriasis.