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No increased risk for psychiatric illness in those with psoriasis taking biologics

Patients with psoriasis prescribed biologic agents are less likely to develop psychiatric illnesses compared with patients not prescribed biologic agents, which researchers concluded is due to treatment selection bias.

“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,” David J. Margolis, MD, PhD, of the department of dermatology at University of Pennsylvania Perelman School of Medicine, and colleagues wrote.

Using EHR data, the researchers compared the rate and likelihood of mental health outcomes between patients with psoriasis (n = 26,208) and without psoriasis (n = 5,832,790), patients with psoriasis prescribed and not prescribed a biologic, and patients with psoriasis prescribed a biologic vs. methotrexate.

The biologic agents included Humira (adalimumab, AbbVie), Enbrel (etanercept, Amgen), Stelara (ustekinumab, Janssen), Taltz (ixekizumab, Eli Lilly) and Cosentyx (secukinumab, Novartis). The evaluation also included Otezla (apremilast, Celgene) and methotrexate.

The mental health outcomes analyzed were any psychiatric illness, depression, psychosis, bipolar disorder, suicide or suicidal ideation.

In those without psoriasis, the average age at entry into the cohort was 38.38 years, and 55.21% of patients were female. In those with psoriasis, the average age at entry was 51.48 years, and 52.99% of patients were female.

A biologic was prescribed in 12.77% of those with psoriasis and 0.21% of those without psoriasis. Patients prescribed a biologic were younger, more likely to be white and less likely to have a history of any medical illnesses. They were also less likely to have a documented psychiatric illness or suicidal ideation than those with psoriasis who were not prescribed a biologic.

“Surprisingly, those prescribed a biologic seemed healthier than those not prescribed a biologic in that they were less likely at their qualifying date to have a history of psychiatric illness, congestive heart failure, chronic kidney disease, myocardial infarction, cerebrovascular accident, diabetes, hypertension or chronic obstructive pulmonary disease,” Margolis and colleagues wrote. – by Abigail Sutton

Disclosures: Margolis reports he receives research funding as the principal investigator via the Trustees of the University of Pennsylvania and the National Institutes of Health, Valeant Pharmaceuticals and Sunovion Pharmaceuticals, and performs consulting as a member of data monitoring boards or scientific advisory boards with Cell Constructs, Kerecis, Leo, Johnson & Johnson, Pfizer and Sanofi. Please see the study for all other authors’ relevant financial disclosures.