This article is more than 5 years old. Information may no longer be current.

Biological agents may reduce fatigue in adults with psoriasis

Biological drugs have a small to moderate effect in reducing fatigue in patients with psoriasis vulgaris, but research is needed to understand the underlying causes in this relationship.

Moreover, the role of disease activity and inflammatory biomarkers on fatigue severity is not entirely understood, researchers said.

A meta-analysis included randomized placebo-controlled trials that compared biological agents in adults with psoriasis in which measures of fatigue were examined before and after treatment. Anti-TNF-alpha agents: infliximab (Remicade, Janssen; Ixifi, Pfizer; Renflexis, Merck) etanercept (Enbrel, Amgen; Erelzi, Sandoz) adalimumab (Humira, Abbvie) and adalimumab-atto (Amjevita, Amgen;) along with the non-anti-TNF-alpha agents: ustekinumab, secukinumab (Cosentyx, Novartis) ixekizumab (Taltz, Lilly) brodalumab (Siliq, Bausch Health), guselkumab (Tremfya, Janssen) and tildrakizumab (Ilumya, Sun Pharmaceuticals) were included in the analysis of eight randomized clinical trials totaling 6,033 patients.

To score fatigue, the studies used either the Short Form 36 Health Survey Vitality Subscale or the Functional Assessment of Chronic Illness Therapy-Fatigue at baseline and primary endpoints, typically at or before 16 weeks.

The researchers found a significant reduction in fatigue after treatment with biological agents compared with placebo, with a standardized mean difference of –0.40 (95% CI, –0.46 to –0.34). They also reported no differences across treatment subgroups nor between anti-TNF-alpha and the other agents.

The findings are comparable to a 2016 meta-analysis on fatigue in patients with rheumatoid arthritis using biological drug interventions, according to the researchers.

“Improvement of fatigue may be the result of a reduction in proinflammatory cytokines acting on the brain, less pain, less depression, an improvement in general health, or a combination of these factors,” Inger Marie Skoie, from the department of dermatology, Stavanger University Hospital, Norway, and colleagues wrote. – by Abigail Sutton

Disclosures: Skoie reports she received honoraria for participation in advisory boards and/or as a speaker for AbbVie, Eli Lilly, Janssen, Leo Pharma and Pfizer and received support as a doctoral research fellow from the Western Norway Regional Health Authority. The other authors report no relevant financial disclosures.