(O) Depression, Anxiety and Adjustment Disorder Among Patients with Psoriasis Receiving Systemic Agents: A Retrospective Cohort Study in Quebec, Canada

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 305

Presenting Author(s)

Raymond Milan, MSc
– McGill University, Department of Medicine, Burlington, Ontario, Canada

Co-Author(s)

Jacques LeLorier
– University of Montreal, Canada
Marie-Josée Brouillette
– McGill University, Canada
Anne Holbrook, PharmD, MD, MSc
– Professor, McMaster University, Hamilton, ON, Canada
Ivan V Litvinov, MD, PhD
– Assistant Professor, McGill University, Montreal, QC, Canada
Elham Rahme, PhD
– Associate Professor, McGill University, Montreal, QC, Canada

Background: Patients with psoriasis are at higher risk of depression, anxiety and adjustment disorder (DAAD) when compared to the general population. Randomized control trials reported improvement in depression and anxiety symptoms among patients with psoriasis receiving tumor necrosis factor inhibitors and ustekinumab (TNFi/UST) vs placebo and conventional systemic agents (CSA). However, the risk of DAAD among TNFi/UST vs CSA users was not assessed in real-world settings.

Objectives: we aimed to examine the incidence of DAAD among patients with psoriasis treated with TNFi/UST vs CSA

Methods: We conducted a retrospective cohort study using the province of Quebec health administrative databases (1997-2015). Among adult patients with a diagnosis for psoriasis and initiating a CSA, we included those who later initiated a TNFi/UST at the date of their first prescription fill (index-date). We also included TNFi/UST non-users at a date chosen to match the time between the first CSA and the index-date of a random TNFi/UST user using prescription-time distribution matching to reduce survival bias. TNFi/UST non-users were classified into current or previous CSA users according to their last CSA received at or before their index-date. Follow-up ended at the first date of DAAD diagnosis entry, death or end of the study period. The first healthcare use for DAAD in follow-up defined incident DAAD. We considered a 3-month latency period to ensure that theses DAAD occurred after index date. Marginal Cox regression models weighted by the inverse adjusted probability of exposure (propensity score) compared the risk of DAAD between TNFi/UST, current and previous CSA users. Additional analyses were conducted by age groups and sex.

Results: The study cohort included 1,333 patients with psoriasis: 183 TNFi/UST users, 625 current CSA users and 525 previous CSA users. Rates of DAAD were 63.3, 55.6 and 33.5 per 1,000 person-year, respectively. TNFi/UST users were at lower risk of DAAD versus previous CSA users (Hazard Ratio 0.48, 95% CI: 0.28-0.94). The reduction in risk among TNFi/UST users was not statistically significant versus current CSA users. Similar results were observed across different age groups and sex.

Conclusions: Among patients with psoriasis, the use of TNFi/UST compared to CSA may be associated with reduced risk of DAAD. It is reassuring that the risk of DAAD was not higher in TNFi/UST users because these agents are prescribed for patients with moderate-to-severe psoriasis in whom CSA use has failed.