No Association Between Biologics to Treat Psoriasis and Psychiatric Illness

Patients with psoriasis are more likely to have mental health issues, but those treated with biologic therapies are less likely to develop psychiatric illnesses compared with patients who are not prescribed biologics, according to a study in Journal of American Academy of Dermatology.

The researchers used a large US electronic medical records (EMRs) database to explore the association of biologic therapy for psoriasis with psychiatric illness. The majority (70%) of the patients captured by the EMR were part of an integrated delivery network and all of the patient’s healthcare encounters in the network were captured by the database.

Patients were included in the study if they had a diagnosis of psoriasis based on codes from 2 distinct patient encounters and a prescription for any biologic therapy, methotrexate, or phototherapy. Patients with psoriatic arthritis were excluded. In a 10% sample of the data set, there were 5,832,790 patients without psoriasis (control group) and 26,208 patients with psoriasis (psoriasis cohort). Compared with the control group, the psoriasis cohort from the sample were more likely to be male, older, white, from the Northeast, and from an area with higher rates of college education.

For patients in the psoriasis cohort who received a biologic, the mean follow-up per person was 3.58 years, while the mean follow-up for patients who did not receive a biologic was 2.62 years. Patients prescribed a biologic were younger, more likely to be white, and less likely to have a history of medical illness.

Consistent with previous studies, the researchers found that patients with psoriasis were more likely to have a diagnosis of any psychiatric illness, depression, bipolar disease, psychosis, suicide, and suicide ideation compared with patients in the control group. However, those prescribed biologics were less likely to develop any psychiatric illness, depression, bipolar disease, psychosis, suicide, and suicide ideation compared with patients with psoriasis not prescribed biologics.

Compared with patients prescribed methotrexate, patients prescribed biologics were less likely to have a psychiatric illness diagnosis, although there was no difference with respect to suicidal ideation and suicide.

“Although it is possible that biologics have a preventative effect on psychiatric illness because there was a decreased likelihood for a multitude of medical illness among those who were prescribed a biologic, it is more likely that those who were selected to receive a biologic were different and perhaps healthier than those not prescribed a biologic,” the authors noted.

Reference

Margolis DJ, Shin D, Noe MH, et al. Lack of association of biologic therapy for psoriasis with psychiatric illness: an electronic medical records cohort study. J Am Acad Dermatol. 2019;81(3):709-716.