Vasilakis-Scaramozza C, Persson R, Hagberg K W, Jick S
Boston Collaborative Drug Surveillance Program, Lexington, MA, USA.
Boston University School of Public Health, Boston, MA, USA.
J Eur Acad Dermatol Venereol. 2020 Aug;34(8):1755-1763. doi: 10.1111/jdv.16231. Epub 2020 Feb 28.
Anxiety and depression are common among psoriasis and psoriatic arthritis (PsA) patients, but rates may differ by treatment.
To quantify the risk of incident treated anxiety, depression and mixed anxiety + depression in users of apremilast compared with users of other treatments for psoriasis and PsA.
We conducted two separate cohort studies of psoriasis and PsA patients treated with apremilast, tumour necrosis factor inhibitor biologics, interleukin-17, -23 or -12/23 inhibitor biologics, conventional DMARDs or systemic corticosteroids in the United States MarketScan database. Cohort entry was date of first study drug after 21 March 2014. We identified cases who had a depression and/or anxiety diagnosis with a prescription for antidepressant/antianxiety medication within 30 days of the diagnosis code. We calculated incidence rates (IRs) and incidence rate ratios with 95% confidence intervals (CIs) for treated anxiety, treated depression and treated anxiety + depression per 1000 patient-years (PY) among patients.
Among the psoriasis cohort, IRs for each outcome were similar between exposure categories and highest among users of systemic corticosteroids alone. IRs (95% CI) for apremilast alone were 9.2 (6.6-12.5), 4.6 (2.8-7.1) and 4.6 (2.8-7.1) per 1000 PY for treated anxiety, treated depression and treated anxiety + depression, respectively. In the PsA cohort, the rate of anxiety was highest among users of apremilast alone; rates of depression and anxiety + depression were similar for apremilast compared with other PsA treatments. IRs for each outcome were also high for users of corticosteroids in both the psoriasis and PsA cohorts.
Among patients with psoriasis, users of apremilast had similar rates of anxiety and depression as users of other non-corticosteroid systemic psoriasis treatments. Among PsA patients, users of apremilast had similar rates of depression and anxiety + depression compared with users of other systemic non-corticosteroid PsA drugs; however, the rate of anxiety was slightly higher.
焦虑和抑郁在银屑病和银屑病关节炎（PsA）患者中很常见，但发病率可能因治疗方法而异。
与其他治疗银屑病和PsA的药物使用者相比，量化阿普米司特使用者发生治疗性焦虑、抑郁以及混合性焦虑 + 抑郁的风险。
我们在美国市场扫描数据库中对接受阿普米司特、肿瘤坏死因子抑制剂生物制剂、白细胞介素 - 17、 - 23或 - 12/23抑制剂生物制剂、传统改善病情抗风湿药（DMARDs）或全身性皮质类固醇治疗的银屑病和PsA患者进行了两项独立的队列研究。队列进入时间为2014年3月21日之后首次使用研究药物的日期。我们确定了在诊断代码后的30天内有抑郁症和/或焦虑症诊断且开具了抗抑郁/抗焦虑药物处方的病例。我们计算了患者中每1000患者年（PY）治疗性焦虑、治疗性抑郁和治疗性焦虑 + 抑郁的发病率（IRs）以及发病率比和95%置信区间（CIs）。
在银屑病队列中，各暴露组每种结局的发病率相似，单独使用全身性皮质类固醇的患者发病率最高。单独使用阿普米司特时，每1000 PY治疗性焦虑、治疗性抑郁和治疗性焦虑 + 抑郁的发病率（95% CI）分别为9.2（6.6 - 12.5）、4.6（2.8 - 7.1）和4.6（2.8 - 7.1）。在PsA队列中，单独使用阿普米司特的患者焦虑率最高；与其他PsA治疗方法相比，阿普米司特的抑郁和焦虑 + 抑郁率相似。银屑病和PsA队列中皮质类固醇使用者的每种结局发病率也很高。
在银屑病患者中，阿普米司特使用者的焦虑和抑郁发生率与其他非皮质类固醇全身性银屑病治疗药物使用者相似。在PsA患者中，与其他全身性非皮质类固醇PsA药物使用者相比，阿普米司特使用者的抑郁和焦虑 + 抑郁发生率相似；然而，焦虑率略高。
