Lack of association of biologic therapy for psoriasis with psychiatric illness: An electronic medical records cohort study - 15/08/19
, Daniel Shin, PhD, Megan H. Noe, MD, MPH, MSCE, Marilyn T. Wan, MBChB, MPH, Ketaki Bhate, MBBS, MSc, Shiyu Wang, MS, Ole Hoffstad, MS, Junko Takeshita, MD, PhD, MSCE, Joel M. Gelfand, MD, MSCEAbstract |
Background |
Psoriasis and biologic therapies have been associated with psychiatric illnesses.
Objective |
To determine if persons with psoriasis or those exposed to biologics are more likely to develop a psychiatric illness.
Methods |
Retrospective electronic medical records cohort study.
Results |
Individuals with psoriasis were significantly more likely to have a history of several medical (eg, cardiovascular illnesses) and psychiatric (eg, depression, suicide) illnesses than those without psoriasis. Those with psoriasis who were prescribed a biologic therapy were significantly less likely than those with psoriasis not prescribed a biologic agent to receive a psychiatric illness diagnosis (hazard ratio for any psychiatric illness 0.52, 95% confidence interval 0.51-0.53, P < .0001). With respect to any psychiatric illness, this finding was confirmed when comparing biologic therapy versus methotrexate treatment (0.80, 95% confidence interval 0.76-0.84, P < .0001).
Limitations |
These findings were likely attributable to treatment selection bias.
Conclusion |
Individuals with psoriasis have an increased risk of several medical and psychiatric illnesses. Individuals with psoriasis prescribed biologic agents are less likely than those not prescribed biologic agents to develop psychiatric illnesses. Most likely because of treatment selection, individuals with psoriasis prescribed biologic therapy are not currently at increased risk of a psychiatric outcome.
Le texte complet de cet article est disponible en PDF.Key words : biologic therapy, bipolar disease, depression, psoriasis, psychiatric illness, suicide
Abbreviations used : CI, FDA, HR, ICD-9, ICD-10, IQR, OEHR, SD
Plan
| Funding sources: Supported by a research grant from Valeant Pharmaceuticals to the Trustees of the University of Pennsylvania (to Dr Margolis, principle investigator). |
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| Conflicts of interest: Dr Margolis receives research funding as the principal investigator via the Trustees of the University of Pennsylvania (R01-AR060962, R01-AR070873, and R01-DK116199) and from the National Institutes of Health and Valeant Pharmaceuticals (PEER study) and Sunovion Pharmaceuticals. None of this funding was used for this study. He performs consulting activities primarily as a member of data monitoring boards or scientific advisory boards with Leo, Johnson and Johnson, Pfizer, Sanofi, Kerecis, and Cell Constructs. None of these activities are associated with the outcomes of this study. Dr Noe is supported by a K23-AR073932 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr Takeshita receives research funding as the principle investigator via the Trustees of the University of Pennsylvania (K23-AR068433) from the National Institutes of Health and Pfizer Inc. She has also received payment for continuing medical education work related to psoriasis that was supported indirectly by Eli Lilly. Dr Gelfand served as a consultant for BMS, Boehringer Ingelheim, GSK, Janssen Biologics, Novartis Corp, UCB (DSMB), Sanofi, and Pfizer Inc receiving honoraria; receives research grants (to the Trustees of the University of Pennsylvania) from Abbvie, Janssen, Novartis Corp, Celgene, Ortho Dermatologics, and Pfizer Inc; and received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly, Ortho Dermatologic, and Novartis. Dr Shin, Ms Wan, Ms Wang, Ms Bhate, and Mr Hoffstad have no conflicts of interest to disclose. |
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| Disclaimer: Valeant Pharmaceuticals and its associates did not participate in any aspects of the design, data collection, analysis, interpretation, or presentation of this study. Associates from Valeant did have an opportunity to review a draft of this manuscript before journal submission. |
Vol 81 - N° 3
P. 709-716 - septembre 2019 Retour au numéro
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