A prospective, interventional assessment of psoriasis quality of life using a nonskin-specific validated instrument that allows comparison with other major medical conditions

BackgroundEach individual psoriasis patient has different expectations and goals for biological treatment, which may differ from those of the clinician. As such, a patient‐centred approach to treatment goals remains an unmet need in psoriasis.ObjectiveThe aim of this study was to review available data on patients’ and physicians’ decision criteria and expectations of biological treatment for moderate‐to‐severe psoriasis with the aim of developing a core set of questions for clinicians to ask patients routinely to understand what is important to them and thus better align physicians’ and patients’ expectations of treatment with biologics and its outcomes.MethodsA literature search was conducted to identify key themes and data gaps. Aspects of treatment relevant when choosing a biological agent for an individual patient were identified and compared to an existing validated instrument. A series of questions aimed at helping the physician to identify the particular aspects of treatment that are recognised as important to individual psoriasis patients was developed.ResultsKey findings of the literature search were grouped under themes of adherence, decision‐making, quality of life, patient/physician goals, communication, patient‐reported outcomes, satisfaction and patient benefit index. Several aspects of treatment were identified as being relevant when choosing a biological agent for an individual patient.The questionnaire is devised in two parts. The first part asks questions about patients’ experience of psoriasis and satisfaction with previous treatments. The second part aims to identify the treatment attributes patients consider to be important and may as such affect their preference for a particular biological treatment. The questionnaire results will allow the physician to understand the key factors that can be influenced by biological drug choice that are of importance to the patient. This information can be used be the physician in clinical decision making.ConclusionThe questionnaire has been developed to provide a new tool to better understand and align patients’ and physicians’ preferences and goals for biological treatment of psoriasis.

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“…A further 22 relevant associated articles were found. Excluding duplications, a total of 52 relevant articles were identified …”

Section: Resultsmentioning

confidence: 99%

A patient‐centred approach to biological treatment decision making for psoriasis: an expert consensus

Strohal

Prinz

Girolomoni

et al. 2015

Acad Dermatol Venereol

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“…There are several established, validated clinical instruments used to measure quality of life (QOL) and psychiatric comorbidities in patients with psoriasis, both in clinical studies and dermatology clinics ( Table 2). [55][56][57][58][59][60][61][62][63] The authors would like to briefly describe some of these tools before discussing the cytokine theory of depression as some correlation between depression and cytokine levels was documented using these kinds of tools. The Columbia classification algorithm for suicide assessment (C-CASA) is a standardized, 8-category rating system that helps to distinguish between suicidal and non-suicidal events.…”

Section: Mental Health and Sib Measures In Dermatology Clinical Studiesmentioning

confidence: 99%

Depression and suicidality in psoriasis: review of the literature including the cytokine theory of depression

Koo

Marangell

Nakamura

et al. 2017

Acad Dermatol Venereol

170

152

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Psoriasis can be a socially isolating disease due to debilitating physical symptoms and the stigma patients feel because of the appearance of their skin. Mental health comorbidities such as anxiety, depression and suicidal ideation and behaviour (SIB) are prevalent in patients with psoriasis. Patients with mild psoriasis can experience psychiatric comorbidities; however, disorders such as depression and SIB are more common in patients with severe psoriasis or psoriatic arthritis. Psychiatric disorders can both result from and contribute to progression of psoriasis, suggesting that psoriasis and psychiatric conditions, such as depression, may have overlapping biological mechanisms. Proinflammatory cytokines such as interleukin (IL)-1 and IL-6 are elevated in both psoriasis and depression, indicating that the inflammatory process may be involved in the progression of both diseases. Elevated cytokine levels in the central nervous system cause physiologic and biochemical changes that may contribute to the development of depression. In this review of the literature, we discuss the evidence that supports the association of psoriasis with mental health disorders and the tools used to detect the presence of these comorbidities. Additionally, we review the most prominent hypotheses on the mechanisms by which the inflammatory response and elevated cytokines can cause depression. These results highlight the role that systemic inflammation plays in the various mental health comorbidities associated with psoriasis, including depression and SIB.

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“…Meta-analysis of other trials Out of 10 non-randomised and/or non-placebo studies, [36][37][38][51][52][53][54][55][56][57] eight provided enough data for meta-analysis involving 1744 patients with data at baseline and follow-up (Figure 2c). 35,36,38,[51][52][53][54][55] Meta-analysis of these studies suggested significant improvement in depressive symptoms following anti-cytokine treatment (SMD = 0.51; 95% CI, 0.34-0.67).…”

Section: Resultsmentioning

confidence: 99%

“…35,36,38,[51][52][53][54][55] Meta-analysis of these studies suggested significant improvement in depressive symptoms following anti-cytokine treatment (SMD = 0.51; 95% CI, 0.34-0.67). There was evidence of significant heterogeneity among these studies (Po0.001; I 2 = 73%).…”

Section: Resultsmentioning

confidence: 99%

Antidepressant activity of anti-cytokine treatment: A systematic review and meta- analysis of clinical trials of chronic inflammatory conditions

Kappelmann

Lewis

Dantzer

et al. 2017

Brain, Behavior, and Immunity

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Inflammatory cytokines are commonly elevated in acute depression and are associated with resistance to monoaminergic treatment. To examine the potential role of cytokines in the pathogenesis and treatment of depression, we carried out a systematic review and meta-analysis of antidepressant activity of anti-cytokine treatment using clinical trials of chronic inflammatory conditions where depressive symptoms were measured as a secondary outcome. Systematic search of the PubMed, EMBASE, PsycINFO and Cochrane databases, search of reference lists and conference abstracts, followed by study selection process yielded 20 clinical trials. Random effect meta-analysis of seven randomised controlled trials (RCTs) involving 2370 participants showed a significant antidepressant effect of anti-cytokine treatment compared with placebo (standardised mean difference (SMD) = 0.40, 95% confidence interval (CI), 0.22-0.59). Anti-tumour necrosis factor drugs were most commonly studied (five RCTs); SMD = 0.33 (95% CI; 0.06-0.60). Separate meta-analyses of two RCTs of adjunctive treatment with anti-cytokine therapy and eight nonrandomised and/or non-placebo studies yielded similar small-to-medium effect estimates favouring anti-cytokine therapy; SMD = 0.19 (95% CI, 0.00-0.37) and 0.51 (95% CI, 0.34-0.67), respectively. Adalimumab, etanercept, infliximab and tocilizumab all showed statistically significant improvements in depressive symptoms. Meta-regression exploring predictors of response found that the antidepressant effect was associated with baseline symptom severity (P = 0.018) but not with improvement in primary physical illness, sex, age or study duration. The findings indicate a potentially causal role for cytokines in depression and that cytokine modulators may be novel drugs for depression in chronically inflamed subjects. The field now requires RCTs of cytokine modulators using depression as the primary outcome in subjects with high inflammation who are free of other physical illnesses.

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A prospective, interventional assessment of psoriasis quality of life using a nonskin-specific validated instrument that allows comparison with other major medical conditions

Cited by 32 publications

References 27 publications

A patient‐centred approach to biological treatment decision making for psoriasis: an expert consensus

A patient‐centred approach to biological treatment decision making for psoriasis: an expert consensus

Depression and suicidality in psoriasis: review of the literature including the cytokine theory of depression

Antidepressant activity of anti-cytokine treatment: A systematic review and meta- analysis of clinical trials of chronic inflammatory conditions

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