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Depression over psoriasis: Assessment of associated relief by addition of adalimumab for the treatment of psoriasis: Observational study (DORADO � Ps)
International Conference on Hospice & Palliative Care
Introduction: Psoriasis is a common chronic condition that affects 1�3% of the general population and estimates suggest
that 0.4�2.3% of the adult population have psoriasis but remain undiagnosed. It is commonly associated with a variety of
psychological difficulties, including poor self-esteem, sexual dysfunction, anxiety, depression, and suicidal ideation. Tumor
necrosis factor (TNF), �± pro inflammatory cytokine, has been implicated in the pathogenesis of both psoriasis and depression.
Patients with psoriasis and depression have elevated levels of TNF. A direct correlation exists between TNF concentrations and
psoriasis symptoms as measured by Psoriasis Area and Severity Index (PASI) scores.
Aim: The aim of this study was to obtain data on the extent of depression among psoriatic patients, the effectiveness of
Adalimumab treatment on the depression symptoms associated with psoriasis and to explore the association between
improvement in depression symptoms and improvement in Psoriasis Area and Severity Index.
Methods: The effects of Adalimumab (40 mg every other week) on ZDS score and PASI at week 24 were assessed. Relationships
between ZDS and PASI were assessed. Changes in ZDS score were compared to patients with and without a 75% or greater
reduction in baseline PASI score. An improvement of 6 points or more in the Zung depression scale was considered a clinically
meaningful improvement. Forty five patients with moderate to severe psoriasis were assessed for depression symptoms at
baseline and week 24 using the Zung Self-rating Depression Scale (ZDS).
Results: At month 6 after starting Adalimumab, 80% of enrolled patients achieved 75% improvement in their PASI score
(PASI75) at month 6 of Adalimumab therapy and 97.8% achieved a meaningful improvement of Zung depression score (more
than 6 points decline in the Zung depression score). Age at time of assessment significantly predicted depression (p=0.030),
with the younger age predicting a higher depression score (standard co-efficient-0.451). Achieving PASI 75 could significantly
predict improvement in depression (p=0.002, standard coefficient-0.746).
Conclusion: From this study, we can conclude that Adalimumab may be associated with relief symptoms of depression in patients with
moderate to severe psoriasis. Reductions in depression symptoms were significantly correlated with reductions in psoriasis severity.